LA Comprehensive and LA Core
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 LA Health Medicine Rate. Medicines not on the medicine list will be funded up to the monthly Chronic Drug Amount (CDA).
Medicine cover for Additional Disease List conditions
You have further cover for Additional Disease List (ADL) conditions. There is no medicine list (formulary) for the ADL conditions. Approved medicine for these conditions will be funded up to the monthly Chronic Drug Amount (CDA).
LA Active and LA Focus
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 LA Health Medicine Rate. Medicines not on the medicine list will be funded up to the monthly Chronic Drug Amount (CDA).
LA KeyPlus
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 LA Health Medicine Rate. Approved medicine that is not on the medicine list will be funded up to Reference Price for the medicines specific medicine category.
LA Comprehensive, LA Core, LA Active, LA Focus
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 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) condition(s) per year.
LA KeyPlus
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 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL)condition(s) per year. You must nominate a GP in the GP network for your benefit option, to be your primary care doctor to manage your chronic conditions. When you visit your nominated network GP for the management of your chronic condition, we'll cover the consultation at 100% of the Scheme Rate (SR). If you see a GP who is not your nominated primary care GP, or your nominated GP is not a network GP, you will experience a co-payment.
LA Comprehensive, LA Core, LA Active, LA Focus and LA KeyPlus
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:
