Medicine cover for Chronic Disease List conditions

The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Scheme Rate. Medicines not on the medicine list will be funded up to the monthly Chronic Drug Amount (CDA).

Medicine cover for Non Chronic Disease List conditions

You have further cover for 2 Non CDL conditions, Depression and Attention deficit hyperactivity disorder. A medicine list (formulary) applies to Depression. For this condition, approved medicine on the medicine list will be funded in full up to the Scheme Rate. Medicines not on the medicine list will be funded up to the monthly Chronic Drug Amount (CDA). A medicine list (formulary) does not apply to Attention deficit hyperactivity disorder. For this condition, approved medicine will be funded up to 80% of the Scheme Rate.

Treatment baskets for your approved Chronic Disease List conditions

The Chronic Illness Benefit will also cover a limited number of selected tests, procedures and specialist consultations each year for the ongoing management of your condition(s). You also have cover for four (4) GP consultations related to your approved PMB CDL condition(s) per year.

How to access the Chronic Illness Benefit

If you want to access cover from the Chronic Illness Benefit, you must apply for it. You must complete a Chronic Illness Benefit application form with your doctor and submit it for review. If your doctor uses HealthID, your doctor can apply for cover online, provided you have given your consent.

You need to meet the benefit entry criteria for your condition(s) to be registered on the Chronic Illness Benefit. You or your doctor may need to provide certain test results or extra information as indicated on the CIB application form for the condition(s) you are applying for. Please ensure that these documents are submitted with your application to avoid any delays in the process.

Documents for your Chronic Illness Benefit (CIB) cover:

Chronic Illness Benefit application form
CIB Analyst to review