Plus Option

Plus Option Benefits Chronic Care

Chronic Care

  • Effective 1 January 2024

  • Members and their dependants are entitled to the following benefits, subject to the provisions of the rules of the Scheme, and in particular the provisions of the statutory Prescribed Minimum Benefits (PMBs).

    This summary is for information purposes only and does not supersede the rules of the Scheme. In the event of any discrepancy, the rules will prevail.

Benefits Description
Chronic conditions

Members' treating doctors or pharmacists must call 0860 767 633 for approval of medicines Subject to chronic condition limits of:
R76 600 per beneficiary or R157 800 per family
Chronic medication One month's supply of certain medication which may be used to treat a PMB condition will be paid once only from your Medical Spending Account (MSA). According to legislation/Scheme rules, PMB medication taken on a chronic basis may not be claimed from a member’s MSA.

You will need to obtain authorisation for these medications to be paid from the chronic benefit. All medication will be subject to Medicine Reference Price (MRP) and use of one of the Scheme's network pharmacies.		 100% of SEP plus agreed dispensing fee
PMB conditions

Unlimited; subject to treatment plan protocols

 100% of SEP plus agreed dispensing fee, or Scheme rate in respect of treatment plan services
All chronic conditions covered, subject to registration on the Scheme's Medicine Risk Management Programme and approval of treatment protocols, except in respect of diabetes types 1 and 2

Click here for more information on the Medicine Risk Management Programme		 Accrues to the chronic condition limit of R72 500 per beneficiary or R149 400 per family 100% of SEP plus agreed dispensing fee (subject to MRP and use of Pick n Pay Medical Scheme Pharmacy Network
Diabetes treatment

Diabetes cover will be subject to registration with, and the protocols of, the Centre for Diabetes and Endocrinology (CDE)
Contact: 011 053 4400		 The Scheme's PMB DTP & CDL Programme offers benefits in accordance with approved treatment plans in respect of the diagnosis, treatment and care for such conditions.

If medicines are voluntarily obtained from a provider other than the Scheme's DSP, co-payments could be applied		 100% of cost if provided through CDE; 70% of SEP, plus agreed dispensing fee if not registered on CDE (subject to the MRP)