The Chronic Illness Benefit
Medicine cover for Chronic Disease List conditions
The Chronic Illness Benefit covers authorised medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. Authorised medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Fund Rate. Medicines not on the medicine list will be funded up to the Maximum Medical Aid Price (MMAP).
Medicine cover for Additional Disease List conditions
You have further cover for Additional Disease List (ADL) conditions. There is no medicine list (formulary) for the ADL conditions. Approved medicine for these conditions will be funded up to the MMAP.
Treatment baskets for your approved Chronic Disease List conditions
The Chronic Illness Benefit will also cover a limited number of selected tests, procedures and specialist consultations each year for the ongoing management of your condition(s). You also have cover for four (4) GP consultations related to your approved PMB CDL condition(s) per year.
How to access the Chronic Illness Benefit
If you want to access cover from the Chronic Illness Benefit, you must apply for it. You must complete a Chronic Illness Benefit application form with your doctor and submit it for review. If your doctor uses HealthID, your doctor can apply for cover online, provided you have given your consent.
You need to meet the benefit entry criteria for your condition(s) to be registered on the Chronic Illness Benefit. You or your doctor may need to provide certain test results or extra information as indicated on the CIB application form for the condition(s) you are applying for. Please ensure that these documents are submitted with your application to avoid any delays in the process.