There is a lot of uncertainty amongst medical aid members around Chronic Illnesses, – such as, what illnesses are actually classified as chronic, what medications are covered, what their rights are, etc. We have put together some very well explained information on chronic illnesses that will hopefully assist you going forward:
Some facts Chronic Illness and Medical Schemes:
• Any medical diagnosis which persists for a considerable period of time could be considered chronic.
• Chronic illnesses generally do not have a cure.
• Chronic illnesses require constant monitoring and management to allow the individual to lead a good quality of life.
• Chronic conditions are becoming more common and happening at younger ages due to our changing lifestyles.
• Even though you may think your condition is chronic, your medical scheme may not and the Medical Schemes Act may not compel schemes to cover that condition. It is therefore important that you know where you stand when it comes to chronic conditions and your benefits.
What are my benefits?
When you are diagnosed with a chronic condition, it’s difficult to understand what you are covered for, how to apply and how to maximize your benefits. Click here to read more on the Discovery Chronic Benefits for 2018/9.
What are my rights?
All Medical Schemes must cover 25 chronic conditions listed in the Medical Schemes Act. Schemes may manage these chronic conditions according to formularies and designated service providers and logarithms. Click here to read more information from the CMS.
Beware of Co-payments & Gaps!
If you don’t take medicine on the formularies, you may exposed to co-payments and gaps. Click here to view the extensive Discovery Health Chronic Illness Benefit medicine list (formulary).