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SA's No 1 Insurance Blog

Well, that depends. First off, if you want your chronic medication paid for you’ve got to put in an application with your medical scheme for chronic illness benefits (motivated by your GP). Then, if it’s approved there are a few payment scenarios that can play out.

If your condition is a PMB (Prescribed Minimum Benefit) then your scheme will pay the medicine cost in full for twelve months ( benefit year is 1st Jan to Dec 31st). Payment of PMB conditions is a statutory requirement.

If it’s a chronic illness then the medicine will be paid for in full if it’s on your medical scheme’s drug / medicine (formulary list).  Give your scheme a call for a copy of the list.

If your “pills” aren’t on the drug / medicine (formulary list), then your medical scheme is going to pay a monthly amount called a CDA (Chronic Drug Amount) for a particular medicine class. So basically that means your medical scheme will pay a rand mount based on your type of plan and the balance will be for your pocket (co-payment)

Are you interested in joining a medical aid scheme?

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The InsuranceFundi Team

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