What is a chronic condition?
A chronic condition is a condition that requires ongoing long-term or continuous medical treatment. However, not all these conditions are necessarily covered by the Society’s Chronic Medicine Benefits. The Society specifies the chronic conditions that qualify for this benefit.
What chronic conditions are covered by the Society?
- Chronic Disease List (CDL) of Prescribed Minimum Benefits conditions
- Listed non-CDL chronic conditions
Chronic Disease List (CDL) of Prescribed Minimum Benefits conditions |
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Medical conditions marked * will only qualify for benefits under specific circumstances. Please contact Mediscor for details in this regard.
In addition to the benefits available in respect of the chronic conditions included in the PMBs, beneficiaries may, subject to the conditions set out in the Benefit Schedule and other provisions of the Society’s Rules, be entitled to a chronic medication benefit in respect of the chronic conditions listed below (referred to as Listed non-CDL chronic conditions).
Listed non-CDL chronic conditions |
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In the case of the treatment of medical conditions reflected in the above table which may attract a PMB entitlement in terms of the diagnosis and treatment pairs as per Annexure A to the Regulations of the Act, they will be reimbursed as a PMB per Regulation 8.
The importance of managing a chronic condition effectively is undeniably vital for long-term wellbeing. That is why the Trustees introduced a new Disease Risk Management (DRM) programme from 2023, in partnership with PPSHA.
As reported in a previous issue of Benefit Beat, the DRM programme is aimed at identifying beneficiaries who are at risk of developing chronic conditions, suffering complications due to existing chronic conditions, or experiencing an advancement of their existing chronic conditions, and then assisting them to better manage these and to maintain or even improve their quality of life.
Registration of those identified Society beneficiaries on the DRM has been completed and newly diagnosed beneficiaries are registered daily. Continuous interaction between PPSHA and the registered beneficiaries will ensure better compliance with agreed treatment plans and ultimately reduce the number of hospital admissions that the Society beneficiaries will experience thereby resulting in significant cost savings for both the Society and members in general.
When would it make sense to register for chronic medicine benefits?
- it will be covered from your acute medicine benefit limit (you will probably exhaust this benefit limit quite quickly); or
- it wil not be covered at all.
However by registering your chronic condition you will have access to a far higher benefit limit for your chronic medicine. In order to encourage beneficiaries to register their chronic conditions, chronic medicine will be paid from the acute limit once and rejected thereafter.
Certain terms and conditions apply to the chronic conditions covered.
What is the benefit for chronic medicines?
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Overall cumulative benefit limit (both CDL PMB and listed non-CDL) |
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All Biologicals |
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Where do I find a designated service provider (DSP) for chronic medicine?
- All Dis-Chem Retail Pharmacies,
- Dis-Chem Direct (Dis-Chem’s Courier pharmacy),
- Cullinan Health & Home Pharmacy,
- The Namaqualand Pharmacy in Springbok, and
- Dr HA Burger in Springbok.
How do I register for chronic medicine benefits?
Alternatively, you may send your prescription via fax to 086 615 1509 or e-mail to preauth@mediscor.co.za.