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.

Chronic conditions we cover on all plans

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

All our plans offer benefits that are far richer than the Prescribed Minimum Benefits.

To access Prescribed Minimum Benefits, certain rules apply.

Learn more about the Chronic Illness Benefit

Watch this video for an overview of how to make the most of your health plan when you are diagnosed with a chronic illness.

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 Smart and KeyCare plans. We pay up to the cost of the generic reference price (GRP) for these plans. The GRP is the cost of the least expensive medicine of the same kind on our medicine list for the condition. 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 Chronic Drug Amount (CDA) for your medicine. No medicine list applies.

Extended chronic medicine list

For members on the Executive Plan, we pay the full cost of medicine on our exclusive medicine list.

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 two days' supply on hand.

Where to get your medicine

Designated service providers (DSPs)

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

  • Priority, Saver, Smart, Core plans and Delta options

    MedXpress Network Pharmacies

  • KeyCare Plus

    You must use a network pharmacy or get your medicine from your chosen primary or secondary GP

  • KeyCare Start plan

    State facility

  • KeyCare Core

    You must use a network pharmacy

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

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 (including HIV/AIDS) on the Chronic Disease List (CDL).

All our plans offer benefits that are far richer than the Prescribed Minimum Benefits (PMBs). To access PMBs, certain rules apply.

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