Your acute medicine benefit won't last long if you use it to treat lasting conditions such as asthma, diabetes or high blood pressure. This is because you need to take medicine regularly and often visit the doctor who treats your condition to make sure the treatment works.
We want to help you to be as healthy as possible. You have access to the Chronic Illness Benefit, which pays for specific medicine, tests and doctor's visits once you register your chronic condition with us. This means you get to keep your acute medicine benefit for unexpected illnesses.
Keep in mind that you should go to one of the Scheme's network providers for your healthcare needs if you want the Scheme to pay the claims in full. This includes network pharmacies.
The Chronic Illness Benefit covers chronic conditions on our lists
Medicine for the Chronic Illness Benefit
The Chronic Illness Benefit covers authorised medicine for the 26 Chronic Disease List (CDL) conditions. It also covers the conditions on the Additional Disease List (ADL) for the Classic Comprehensive plan.
Authorised medicine on the medicine list (formulary) will be paid in full up to the Scheme Rate. There is a list of medicines approved for these conditions. We will pay for medicines that are not on the medicine list up to the Chronic Drug Amount (CDA. For Additional Disease List conditions, we pay for approved medicines for these conditions up to the Chronic Drug Amount (CDA). The CDA is a monthly amount we pay up to for a medicine class. This applies to medicine that is not listed on the medicine list (formulary). The Chronic Drug Amount includes VAT and the dispensing fee.
You can get details of the CDL and ADL conditions on the Scheme's website at www.discovery.co.za.
If your condition is one of the CDL or ADL conditions and you meet the clinical entry criteria (specific tests must show that you have the condition), you can register for the Chronic Illness Benefit.
How to register
- If your treating doctor is part of our network, they can use HealthID (an app) to apply for the Chronic Illness Benefit if you give your consent.
- You and your treating doctor can complete the Chronic Illness Benefit application form and send it to us. You can download the Chronic Illness Benefit application form from the Scheme's website at www.discovery.co.za. Alternatively, members can phone us on 0860 100 421 and healthcare professionals can phone 0860 44 55 66 to get you registered.