The Chronic Illness Benefit
This is available on all health plans (Executive, Comprehensive, Priority, Saver, Smart, Core, KeyCare plans)
Medicine cover for Chronic Disease List conditions
The Chronic Illness Benefit covers approved medicine for the 27 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions on all plans. Approved medicine on the Chronic Illness Benefit medicine list (formulary will be funded in full up to the Scheme Rate. Medicines not on the medicine list will be funded up to the Chronic Drug Amount (CDA). The CDA does not apply to the Smart and Keycare plans. On these plans approved medicine that is not on the formulary will be funded up to the Reference Price for the medicines specific medicine category. )
Medicine cover for Additional Disease List conditions
Members on the Executive and Comprehensive Plans (except the Classic Comprehensive Smart plan) have further cover for Additional Disease List (ADL) conditions. You can find out more in the benefit guide.
Specialised Medicine and Technology benefit
The Specialised Medicine and Technology benefit gives members on the Executive and Comprehensive plans access to specific high cost medicines and new technologies. This benefit is not available on the Classic Smart Comprehensive plan. Read more on this benefit in the Specialised Medicine and Technology document.
Full cover for medicine on the Executive plan
For members on the Executive plan, we pay the full cost of the medicine on the exclusive list of medicine. You can find the list of exclusive medicine in Cover for medicine and treatment of chronic conditions document.