Chronic Care

• Network Option members must call 0800 765 432 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

  NETWORK OPTION: Members must fax their chronic application forms to 021 673 1815 or email it to [email protected]. Call 0800 765 432 for any queries.

• WHAT ARE PRESCRIBED MINIMUM BENEFITS (PMBs)?

  PMBs are a set of defined benefits to ensure that all Fund members have access to certain minimum health services, regardless of the option they have selected.

• Members on the Network Option with chronic conditions must register on the Chronic Medication Risk Management Programme and obtain pre-authorisation for their medication and approval from their network GP or network specialist on their condition, in order to obtain benefits.

  On approval of your PMB-related chronic condition, a treatment plan, which lists additional services recommended to treat your chronic condition will be sent to you.

  Medication for the 26 PMB conditions will be restricted to the formulary at the network providers (GPs and specialists).

  Click here to view formulary medication.

  Call 0800 765 432 to register.

The 26 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 (heart) failure	Epilepsy	Rheumatoid arthritis
Cardiomyopathy disease (disease of the heart muscle)	Glaucoma	Schizophrenia
Chronic renal (kidney) disease	Haemophilia	Systemic lupus erythematosus
Coronary artery (heart) 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 Call 0800 765 432
Chronic medication non-PMBs	No benefit
Speciality chronic medication benefits (biological)	No benefit