What is covered?
As a Tsogo Sun Group Medical Scheme 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
This also includes medicine such as prescribed schedule 0, 1 and 2 medicine and lifestyle enhancing products.
CLASSIC COMPREHENSIVE
- We will pay up to 100% of the Scheme Rate for medicine from the available funds in your Medical Savings Account (MSA).
- These claims will not accumulate to the Annual Threshold.
CLASSIC SAVER
- We will pay up to a maximum of 100% of the Scheme Rate for medication from the available funds in your Medical Savings Account (MSA).
Cover for acute or day-to-day prescribed medicine
Acute medicine is medicine that is prescribed for a short while for a condition or illness that is not long-lasting.
Acute, homeopathic or naturopathic medicine includes medicine, material for injections and vaccinations prescribed by a person legally entitled to prescribe, such as your GP.
You have cover for prescribed acute medicine from your available day-to-day benefits as follows:
CLASSIC COMPREHENSIVE
- We will pay up to a 100% of the Scheme Rate for medication from your available Medical Savings Account (MSA).
- Claims for medicine on the Preferred Medicine List will accumulate up to 100% of the Scheme Rate for medicine towards the Annual Threshold. It will pay from the Above Threshold Benefit (once reached) at up to 100% of the Scheme Rate.
- Claims for medicine that are not on the Preferred Medicine List will accumulate up to 75% of the Scheme Rate for medicine towards the Annual Threshold. It will pay from the Above Threshold Benefit (once reached) for up to 75% of the Scheme Rate.
- There is an annual limit for prescribed medicine which is prorated for members that join during the year.
CLASSIC SAVER
- We will pay up to a 100% of the Scheme Rate for medication from the available funds in your Medical Savings Account (MSA).
Cover for chronic medicine
You have access to a list of medical conditions and treatments under Prescribed Minimum Benefits (PMBs). The PMBs cover the 26 chronic conditions on the Chronic Disease List. To access PMB cover, you need to meet certain criteria.
Find more information on the Chronic Illness Benefit medicine list.