Cover for Medicine
What is covered?
As a LA Health member, your cover for medicine includes cover for Over the Counter (OTC), acute (day-to-day prescribed) and chronic medicine.
Cover for Self-medication: Over the Counter (OTC) medicine
The Scheme has reviewed the over-the-counter (OTC) benefit limits introduced on 1 January 2025, taking into account recent medicine price increases and feedback from members.
Effective 1 August 2025, the OTC limits will be increased by just over 20%
- For single members: from R2,500 to R3,000
- For families: from R4,500 to R5,500
If the Scheme has already paid OTC claims for you this year, then your available balance - after 1 August 2025 - can be calculated by subtracting the amount already paid by the Scheme from the new annual limit.
The Trustees are considering additional changes to the OTC benefit for implementation in 2026. Details of any changes will be shared with you in the year-end communication in October.
Cover for Acute or Day-to-day Prescribed Medicine
Acute medicine is medicine that is prescribed for a short-term condition or illness that is not long lasting. You have cover for prescribed acute medicine from your available day-to-day benefits.
Acute, homeopathic or naturopathic medicine includes medicine, material for injections and vaccinations prescribed by a person legally entitled to prescribe.
Cover for Chronic Medicine
You have access to a list of medical conditions and treatments under Prescribed Minimum Benefits (PMB). These PMBs cover the 26 chronic conditions on the Chronic Disease List. To access PMB cover, you need to meet certain terms and conditions.
Please find more information on the Chronic Illness Benefit here.
If you are a member on LA Comprehensive or LA Core, you also have access to chronic cover for a list of conditions (the Additional Chronic Disease List). You can find the list here.