Cover for chronic conditions
The Chronic Illness Benefit provides cover for
Medicine for conditions where ongoing medicine is required for a period of three consecutive months or longer. This will include the list of 27 conditions (including HIV and AIDS) known as the Chronic Disease List (CDL).
You can start claiming for chronic medicines once we have approved your cover. You need to complete a Chronic Illness Benefit application form with your doctor and send it to us.
We will then review your application and tell you if your cover has been approved. You can get the latest Chronic Illness Benefit application form here.
When approved for a Chronic Disease List condition, you also have access to a treatment basket of consultations, tests and procedures for the diagnosis and ongoing management of your condition.
How we pay for chronic medicine
We pay for medicine up to a maximum of the Scheme Medicine Rate. The Scheme Medicine Rate for medicines is the price of medicine as well as a fee for dispensing it. The MultiChoice Medical Aid Scheme takes part in the Discovery Health negotiated contracts with over 2 000 pharmacies, who have agreed to charge no more than this rate. If you use a pharmacy outside of this network, you may have a co-payment on the dispensing fee charged by the pharmacist.
Chronic cover for the Prescribed Minimum Benefits is covered in full if you use a Network pharmacy and have registered for chronic cover.
Chronic cover has an annual limit. Log into the Limits page to see more.
Once the annual benefit limit is exceeded we pay claims for Prescribed Minimum Benefit related conditions at the Scheme Medicine Rate.