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l Chronic Medicine
Comprehensive Option
As a member of SAB Medical Aid, you have access to cover for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. This is a defined list of conditions all medical scheme members have cover for to ensure access to certain minimum healthcare services, regardless of the Option they chose. This cover includes funding for the diagnosis, recommended treatment and ongoing care for the listed conditions.
Once we approve cover for your condition, you have automatic access to specific medicine and items to treat your condition as well as a treatment basket. Click here to view the document on treatment that cover your approved PMB CDL condition/s. You also receive cover for four GP consultations for your registered PMB CDL condition/s a year.
The number of tests and consultations are calculated based on the number of months left in the year at the time cover for your condition is approved. If you have cover for the same procedures or tests from more than one basket, funding is limited to the basket that provides the most procedures or tests.
Should you require more cover than what is included in the treatment basket, your doctor may follow an appeals process to request extra funding for the tests, procedures and consultations which you need. Your doctor needs to complete a Request for additional cover for approved Chronic Disease List conditions form and submit it for review. It is important to note that an appeals process does not guarantee automatic approval for the additional cover.
If you were recently diagnosed with, and approved for cover for a PMB CDL condition, the expenses related to the diagnosis of the condition may be paid from the Chronic Benefit and not from other available benefits, as long as your membership of the Scheme was active and valid when your condition was diagnosed.
Your Option also gives you cover for an additional list of chronic conditions that are not listed as PMBs. We call this list the Additional Disease List.
