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Chronic Conditions

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What chronic conditions are covered by the Society?

Chronic Disease List (CDL) of Prescribed Minimum Benefits (CDL PMB) conditions:
  1. Addison Disease
  2. Asthma
  3. Bipolar Mood Disorder
  4. Bronchiectasis
  5. Cardiac Failure
  6. Cardiomyopathy
  7. Chronic Obstructive Pulmonary Disease
  8. Chronic Renal Disease
  9. Coronary Artery Disease
  10. Crohn Disease
  11. Diabetes Insipidus *
  12. Diabetes Type 1 & 2
  13. Dysrhythmia
  1. Epilepsy
  2. Glaucoma
  3. Haemophilia *
  4. HIV/AIDS
  5. Hyperlipidaemia
  6. Hypertension
  7. Hypothyroidism
  8. Multiple Sclerosis *
  9. Parkinson Disease
  10. Rheumatoid Arthritis
  11. Schizophrenia
  12. Systemic Lupus Erythematosus
  13. Ulcerative Colitis

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 Rules, be entitled to a chronic medication benefit in respect of the chronic conditions listed below (non-prescribed conditions covered):
  1. Acne
  2. Allergic Rhinitis
  3. Attention Deficit Hyperactivity Disorder
  4. Alzheimer Disease
  5. Ankylosing Spondylitis
  6. Benign Prostatic Hyperplasia §
  7. Cushing’s Disease §
  8. Cystic Fibrosis
  9. Venous Thromboembolism §
  10. Gastro-oesophageal Reflux Disorder
  11. Gout
  12. Hypoparathyroidism §
  13. Hyperthyroidism §
  14. Incontinence
  15. Depression
  1. Meniere Disease
  2. Menopausal and Perimenopausal Disorders §
  3. Motor Neuron Disease
  4. Myasthenia Gravis §
  5. Osteoarthritis
  6. Osteoporosis
  7. Paget Disease §
  8. Paraplegia, Quadriplegia §
  9. Peripheral Arterial Disease §
  10. Pituitary Adenomas §
  11. Psoriasis
  12. Pulmonary Interstitial Fibrosis §
  13. Stroke / Cerebrovascular Accident §
  14. Systemic Connective Tissue Disorders (incl. Scleroderma and Dermatomyositis)

Medical conditions marked § may attract entitlement to PMBs in terms of the diagnosis and treatment pairs as per Annexure A to the Regulations of the Medical Schemes Act.
 

Chronic medication formulary

A formulary is a list of medicines developed by clinical experts founded on evidence based medicine showing the effectiveness of these medicines in treating a particular disease whilst remaining cost effective. The Society will pay the full cost of such medicines as listed in its formulary to treat a particular chronic disease.

In its drive to continue providing members a cost effective medical aid and to contain contribution increases, the Society constantly reviews the benefits provided as well as any new developments in the industry. Many medical aids now have a chronic medicine formulary in place to ensure that members receive appropriate treatment at a fair and reasonable cost to all members in the scheme. In view of this, the Society will be introducing a medicine formulary for the PMB chronic conditions. The introduction of a formulary will save the Society and its membership approximately R2 million per annum for chronic medicine benefits without compromising the quality of care that members currently receive.

Please note that the Generic Reference Pricing (GRP) practice remains in place. Should a doctor prescribe a medicine from the formulary for which a generic product and price exists, members will be required to switch to the generic product within the formulary in order to avoid any further co–payments as per current practice.

Search for a medicine that falls within the Society’s formulary

If you have any questions about whether your condition or medicine will be covered, please contact Mediscor.

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