The Chronic Illness Benefit
This is available on all health plans (Executive, Comprehensive, Priority, Saver, Smart, Core, KeyCare plans)
Medicine cover for Chronic Disease List conditions
The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions on all plans. Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Scheme Rate. Medicines not on the medicine list will be funded up to the Chronic Drug Amount (CDA). The CDA does not apply to the Smart and Keycare plans. On these plans we pay up to the Generic Reference Price (GRP), which is up to the least expensive medicine of the same kind on our medicine list for the condition.
Please refer to page 4 of the Cover for medicine and treatment of chronic conditions, document for the list of PMB CDL conditions.
Medicine cover for Additional Disease List (ADL) conditions
Members on the Executive and Comprehensive Plans (except the Classic Smart Comprehensive plan) 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 Chronic Drug Amount (CDA). Please refer to page 5 of the Cover for medicine and treatment of chronic conditions, document for the list of ADL conditions.