What is covered
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.
All our plans offer benefits that are far richer than the Prescribed Minimum Benefits.
To access Prescribed Minimum Benefits, certain rules apply.
Medicine
Medicine listMedicine 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 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:
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Priority, Saver, Core plans and Delta options
MedXpress or MedXpress Network Pharmacies
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KeyCare Plus and KeyCare Core plans
You must use a network pharmacy or your allocated GP
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Smart plans
MedXpress, or at your nominated pharmacy network (Dis-Chem or Clicks)
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KeyCare Start plan
State facility
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 on the Chronic Disease List (CDL).