Prescribed Minimum Benefits
The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. We will pay your approved medicine in full if it is on our medicine list (formulary). If your approved medicine is not on our medicine list, we will pay your chronic medicine up to a set monthly amount, called the Chronic Drug Amount (CDA), for each medicine class. The CDA does not apply to the LA KeyPlus Benefit Option. On this Option we cover up to the Generic Reference Price (GRP), which is up to the lowest cost medicine of the same kind on our medicine list for the condition.
If you use more than one medicine in the same medicine class, where both medicines are not on the medicine list, or where one medicine is on the medicine list and the other is not, we will pay for both medicines up to the one monthly CDA for that medicine class.
If you choose to use medicine that is not on our medicine list, you may have a co-payment. You will need to pay these co-payments yourself.
- If a condition is listed as a Prescribed Minimum Benefit, by law all medical schemes must cover the medicine and certain treatment and care for the condition.