Chronic Illness Benefit

Conditions we cover

The Chronic Illness Benefit (CIB) covers you for a defined list of chronic conditions. You need to apply to have your medicine covered for your chronic condition.

Prescribed Minimum Benefit (PMB) conditions

You have access to treatment for a list of medical conditions under the Prescribed Minimum Benefits (PMBs). The PMBs cover the 26 chronic conditions on the Chronic Disease List (CDL).

All our plans offer benefits that are far richer than the PMBs. To access PMBs, certain rules apply.

Chronic conditions we cover on all plans

Click here to find out more about the chronic conditions we cover

Medicine we cover

Medicine cover for the Chronic Disease List conditions

You get full cover for approved chronic medicine on our medicine list. For medicine not on our list, we cover you up to a set monthly rand amount called the Chronic Drug Amount (CDA). The CDA does not apply to the Smart and KeyCare plans, on these plans the cost of the lowest formulary listed drug will apply. You may have a co-payment if you use medicine that is not on the medicine list.

Medicine cover for the Additional Disease List conditions

The Executive and Comprehensive plans, except the Classic Smart Comprehensive plan, offer cover for medicine on the Additional Disease List (ADL). You are covered up to the set monthly CDA for your medicine. No medicine list applies.

Extended chronic medicine list

Members on the Executive Plan also have full cover for an exclusive list of brand medicines.

How we pay for medicine

We pay for medicine up to a maximum of the Discovery Health Rate for medicine. The Discovery Health Rate for medicine is the price of the medicine as well as the fee for dispensing it. To avoid exceeding your annual chronic medicine quantity limit, please use your medicine as prescribed and only order another supply when you have 2 days supply on hand.

Where to get your medicine

Designated service providers (DSP)

On certain plans, to avoid a 20% co-payment, you need to use these DSPs:

Priority, Saver, Core plans and Delta options | MedXpress or MedXpress Network Pharmacies
Smart plans | MedXpress Courier, Clicks or Dischem
KeyCare Plus and KeyCare Core plans | You must use a network pharmacy or your allocated GP
KeyCare Start plan | State facility

On other plans, you can use a pharmacy in our pharmacy network.

Important information you should know

Chronic Illness Benefit application form (PDF)
Cover for medicine and treatment of chronic conditions (PDF)
Chronic Illness Benefit (CIB) medicine list (formulary) (PDF)
PMB treatment baskets (PDF)
Request for additional cover for conditions registered on the CIB (PDF)