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 27 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
Chronic Disease List (CDL) conditions

Addison’s disease, asthma, bipolar mood disorder, bronchiectasis, cardiac failure, cardiomyopathy, chronic obstructive pulmonary disease, chronic renal disease, coronary artery disease, Crohn’s disease, diabetes insipidus, diabetes Type 1, diabetes Type 2, dysrhythmia, epilepsy, glaucoma, haemophilia, HIV, hyperlipidaemia, hypertension, hypothyroidism, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, schizophrenia, systemic lupus erythematosus, ulcerative colitis

Additional chronic conditions we cover on Executive and Comprehensive plans
Additional Disease List (ADL) conditions

Ankylosing spondylitis, Behςet’s disease, cystic fibrosis, delusional disorder, dermatopolymyositis, generalised anxiety disorder, Huntington’s disease, major depression, muscular dystrophy and other inherited myopathies, myasthenia gravis, bsessive compulsive disorder, osteoporosis, isolated growth hormone deficiency, motor neuron disease, Paget’s disease, panic disorder, polyarteritis nodosa, post-traumatic stress disorder, psoriatic arthritis, pulmonary intestinal fibrosis, Sjögren’s syndrome, systemic sclerosis, Wegener’s granulomatosis 

 
 
 
 
 
 
 
 

Medicine we cover

Medicine cover for the Chronic Disease List

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 you will have to pay for medicine that is not on the medicine list.

Medicine cover for the Additional Disease List

The Executive and Comprehensive plans 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.

 
 
 
 

Where to get your medicine

Designated service providers (DSP)

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

  • Delta options and Core plans | MedXpress or MedXpress network pharmacies
  • Smart plans | MedXpress, MedXpress network pharmacies, Clicks or Dis-Chem
  • KeyCare plans | You must use a network pharmacy or your allocated GP

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

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