Chronic medicine
Chronic medicine – who qualifies for it and how to apply for it
Chronic medicine is medicine that must be taken regularly due to a chronic illness such as high blood pressure, asthma, diabetes, etc. This means that if the medicine is not taken, the patient could suffer negative health implications.
We cover approved chronic medicine from the chronic medicine benefit limit and up to 100% of the Fund Medication Rate. If you choose a medicine that costs more than the Fund Medication Rate, we will still provide cover from the chronic medicine benefit limit, but you may have co-payments. The Fund will not apply any limits on the benefit amounts for a chronic condition that is recognised as a Prescribed Minimum Benefit (PMB) and prescribed according to the Medical Schemes Act.
Chronic Disease List
- Addison’s disease
- Asthma
- Bipolar mood disorder
- Bronchiectasis
- Cardiac failure
- Cardiomyopathy
- Crohn’s disease
- Chronic obstructive pulmonary disease (emphysema)
- Chronic renal disease
- Coronary artery disease
- Diabetes insipidus
- Diabetes mellitus type 1
- Diabetes mellitus type 2
- Dysrhythmia
- Epilepsy
- Glaucoma
- Haemophilia
- HIV and AIDS
- Hyperlipidaemia (high cholesterol)
- Hypertension (high blood pressure)
- Hypothyroidism
- Multiple sclerosis
- Parkinson’s disease
- Rheumatoid arthritis
- Schizophrenia
- Systemic lupus erythematosis
- Ulcerative colitis
Additional conditions covered under the Chronic Illness Benefit on the N Option Plus only
- Allergic rhinitis where it forms part of a patient’s asthma treatment
- Alzheimer’s disease
- Attention deficit disorder (prescribed by neurologist, paediatrician or psychiatrist)
- Clinical depression (if treated by psychiatrist)
- Chronic back problems
- Cystic fibrosis
- Endometriosis (limited to six months’ treatment)
- Gastro-oesophageal reflux (gastroscopy report required)
- Gout
- Malabsorption
- Peripheral vascular disease
- Psoriasis
- Organ transplant
- Osteoporosis (bone density test required)
How to apply for chronic medicine benefits
If you suffer from any of the illnesses on our list, you have to register for this benefit before you will have access to cover. If you don’t apply and therefore not qualify for the chronic medicine benefit, your day-to-day medicine benefit will cover the medicine. The minimum requirements to qualify for cover for your chronic condition are detailed on the application form.
How to renew the chronic medicine benefit
You must renew your benefits for chronic medicine every six or 12 months. Please check the letter of approval for the date on which the benefit for chronic medicine expires. If you do not arrange renewing your benefit for chronic medicine, it will fall under the acute medicine limit after the expiry date.
View more information on the Diabetes Programme.