Make your health outlast your day-to-day benefits

Your day-to-day benefits won’t last long if you use them to treat lasting conditions like asthma, diabetes or high blood pressure.

If you have a chronic condition, you need to take medicine and talk to your doctor to make sure the treatment is working to keep you as healthy as possible. If you’re registered on the Chronic Illness Benefit, you get to keep your day-to-day benefits for unexpected illness and still have cover for the care you need.

Once you register for the Chronic Illness Benefit, we pay for the diagnosis, approved treatment and a limited number of selected tests, procedures and doctor consultations for the ongoing management of your condition. You also have cover for four visits a year to your GP for your condition.

The doctor who diagnoses you should be able to tell you if your condition is on the Chronic Disease List. The list has 26 chronic conditions we cover if you meet the requirements.

You must register for the Chronic Illness Benefit

You do not automatically get benefits when you find out you have a condition listed on the Chronic Disease List. If you do not apply for the Chronic Illness Benefit, we pay for your medicine from your day-to-day benefits as long as funds are available. You and your doctor have to complete the Chronic Illness Benefit application form and send it to us. Depending on your condition, a specialist may have to complete the form.

Download the application form by logging in to www.discovery.co.za, choosing Find documents and your certificates and clicking on Apply for the Chronic Illness Benefit (PDF). The form tells you which conditions we cover and what supporting documents you need to send us to register. The form is also available on the company website: Pulse: Department> Human Resources> Forms> Medical Aid and Store Portal: Human Resources> Documents> Forms> All Forms> Human Resources.

Avoid having to pay part of the cost yourself

To get full cover from the Chronic Illness Benefit:

Your medical condition must be on the Chronic Disease List (CDL).
You and your doctor must apply for cover from the Chronic Illness Benefit and send us proof that you have the condition. We only approve certain treatment and there are limits to cover.
You must use a doctor and healthcare providers in our networks for us to pay your claims in full. If you use a healthcare provider who isn’t part of our network, you may have to pay part of the claim yourself.
Your medicine has to be on our list (formulary).

What if my medicine is not on your list?

We know the medicine on our medicine list works, which is why you won’t have to pay in if you get this medicine from a pharmacy in our network. It’s a bit more complicated if your approved medicine is not on our medicine list.

You get full cover for approved medicine on the medicine list. For medicine not on the list, or a combination of medicine on and off the medicine list that are in the same medicine class, we cover up to a monthly rand amount called the Chronic Drug Amount (CDA). The CDA is an amount of money that has been allocated for each medicine class each month.

Examples of how we pay medicine when the Chronic Drug Amount (CDA) applies

Example 1
If a medicine on the medicine list costs R50; and the Chronic Drug Amount is R100, we will pay the medicine in full because it is on the medicine list and R50 will remain to pay towards the cost of the item not on the medicine list.

Example 2
If a medicine on the medicine list costs R150 and the Chronic Drug Amount is R100, we will pay this medicine in full because it is on the medicine list but nothing will remain to pay towards the cost of the item not on the medicine list so you will have to pay the entire cost of the item not on the medicine list.

Example 3

IF:
Medicine A = R150
Medicine B = R100
Chronic Drug amount = R150

We pay as follows:
R150 + R100 = R250 - R150 = R100
Amount due for your own pocket = R100

We explain exactly how we pay for your medicine when we send your approval letter. Please read it carefully to make sure you understand your cover.