Comprehensive Option
Chronic Care
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PMB CHRONIC CONDITIONS
Members on the Comprehensive Option will be required to register on the Chronic Medication Risk Management Programme to ensure that their PMB chronic medication is approved. Members who require chronic medication for one of the 26 PMBs will receive a treatment plan. A treatment plan lists additional services recommended to treat your chronic condition. These services are recommended in order to maintain optimal health, and benefits are covered by the Fund and are not paid from your MSA. The medication will be paid subject to the Fund's approved formulary.
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NON-PMB CHRONIC CONDITIONS
Members are required to register on the Chronic Medication Risk Management Programme to ensure that their non-PMB chronic medication is approved. The medication will be paid subject to the Fund's approved formulary.
Click here to view formulary medication.
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Comprehensive Option members must call 0802 228 922 for their Chronic Care application forms and queries.
Please click here to read more and locate a network pharmacy near you.
- WHAT IS CHRONIC CARE?
Chronic care refers to the medical care for a pre-existing or long-term illness where medication is required to be taken for a period exceeding three months at a time. The Fund provides a Chronic Medication Risk Management Programme to the benefit of members who have been diagnosed with certain chronic conditions.
- YOU MUST OBTAIN PRE-AUTHORISATION FOR ALL CHRONIC MEDICATION
- WHAT ARE PRESCRIBED MINIMUM BENEFITS (PMBs)?
| The 26 common chronic health conditions on the chronic disease list (CDL) | ||
|---|---|---|
| Addison's disease | Crohn's disease | Hypertension (high blood pressure) |
| Asthma | Diabetes insipidus | Hypothyroidism |
| Bipolar mood disorder | Diabetes mellitus types 1 & 2 | Multiple sclerosis |
| Bronchiectasis | Dysrhythmia (irregular heartbeats) | Parkinson's disease |
| Cardiac failure | Epilepsy | Rheumatoid arthritis |
| Cardiomyopathy disease (disease of the heart muscle) |
Glaucoma | Schizophrenia |
| Chronic renal disease | Haemophilia | Systemic lupus erythematosus |
| Coronary artery disease | HIV/AIDS | Ulcerative colitis |
| Chronic obstructive pulmonary disorder (COPD) | Hyperlipidaemia (high cholesterol) | |
| Benefits | Description | |
|---|---|---|
| Chronic medication 26 PMB conditions |
100% of approved medication Subject to registration on the Chronic Medication Risk Management Programme You will receive a treatment plan listing the additional services recommended to treat your approved chronic condition. These services are paid by the Fund and not from your MSA Call 0802 228 922 |
100% of approved medication |
| Chronic medication non-PMB conditions |
Limited to R33 870 per Beneficiary per year for approved medication Subject to registration on the Chronic Medication Risk Management Programme Call 0802 228 922 |
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| Speciality chronic medication benefits(biological) |
Limited to R182 500 per Beneficiary per year Subject to registration on the Chronic Medication Risk Management Programme Call 0802 228 922 |