CHRONIC CONDITIONS

PMB Chronic Disease List (CDL) conditions – All Plans

  • Addison’s disease
  • Asthma
  • Bipolar mood disorder
  • Bronchiectasis
  • Cardiac failure
  • Cardiomyopathy disease
  • Chronic obstructive pulmonary disease (emphysema)
  • Chronic renal disease
  • Coronary artery disease (angina pectoris and ischaemic heart disease)
  • Crohn’s disease
  • Diabetes insipidus
  • Diabetes mellitus type 1
  • Diabetes mellitus type 2
  • Dysrhythmias
  • Epilepsy
  • Glaucoma
  • Haemophilia
  • Hyperlipidaemia
  • Hypertension (high blood pressure)
  • Hypothyroidism
  • Multiple sclerosis
  • Parkinson’s disease
  • Rheumatoid arthritis
  • Schizophrenia
  • Systemic lupus erythematosus
  • Ulcerative colitis

 

Additional Chronic Diseases

In addition to the chronic diseases covered as Prescribed Minimum Benefits, the Fund offers cover for certain additional conditions and up to different limit amounts, depending on the Plan you are on.

Hospital Plan Network / Network SELECT  Plan Savings Plan Traditional / Traditional SELECT  Plan Traditional Plus / Traditional Plus SELECT  Plan
R4 780 per family per benefit year   R4 780 per family per benefit year R11 600 per family per benefit year R13 900 per family per benefit year
  • Chronic Hepatitis
  • Depression
  • Macular Degeneration and Oedema
  • Anxiety
  • Post-Traumatic Stress Disorder

The following non-PMB chronic conditions are covered by Universal Healthcare. Registration and approval required and medicine subject to the Universal Healthcare Chronic Medicine formulary:

  • Acne
  • Allergic rhinitis
  • Cardiac Arrhythmia
  • Depression
  • Gout
  • Female Hormone Replacement Therapy
  • Migraine
  • Osteoarthritis

In addition, the Fund offers cover for:

  • Chronic Hepatitis
  • Macular Degeneration and Oedema
  • Anxiety
  • Post-Traumatic Stress Disorder
  • Chronic Hepatitis
  • Depression
  • Macular Degeneration and Oedema
  • Anxiety
  • Post-Traumatic Stress Disorder

The following conditions are subject to the non-PMB Chronic Medicine Benefit limit:

SUBJECT TO LIMIT ONLY

  • Acne (cystic nodular)
  • Allergic rhinitis (if beneficiary has asthma or is under 12 years)
  • Alzheimer’s disease
  • Anxiety
  • Attention deficit hyperactivity disorder (ADHD)
  • Chronic Hepatitis
  • Depression
  • GORD (if linked to one of the following PMB conditions: asthma, Crohn’s Disease, rheumatoid arthritis or ulcerative colitis)
  • Gout
  • Hyperfunction of pituitary gland
  • Hyperthyroidism (thyrotoxicosis)
  • Hypofunction of pituitary gland
  • Hypoparathyroidism
  • Macular degeneration and Oedema
  • Migraine (prophylactics therapy)
  • Myasthenia gravis and myoneural disorders
  • Osteoarthritis
  • Osteoporosis
  • Post-Traumatic Stress Disorder
  • Psoriasis

UNLIMITED ONCE NON-PMB CHRONIC MEDICINE LIMIT EXCEEDED

  • Cushing’s disease
  • Cystic fibrosis
  • Deep vein thrombosis
  • Hormone replacement therapy

 

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