Chronic Medication

What you need to know about applying to your medical scheme

Yolanda* a 39-year-old nursing sister was recently diagnosed with hypertension (high blood pressure). Her doctor has advised that she take medication for (check how long this is treated). As this is a chronic condition (long-term), Patricia as a medical scheme member, should be covered.

Patricia’s condition requires her to take the relevant medication. Even though she is required to do so, making some changes in her lifestyle can help reduce the amount of medicine she must take. However, if her blood pressure can only be controlled with medicine, she will need to take the medicine for the rest of her life.

What is a chronic disease?

A chronic disease is a condition that requires ongoing medical treatment. These types of diseases are generally ones that are hereditary a result of factors such as poor diet and living conditions. Such a disease is not typically contracted from another person i.e. it is not contagious, because chronic illnesses are not caused by infection. Therefore, the term chronic commonly applies to conditions that can be treated but not necessarily cured. There are 25 standard chronic diseases, which are:

Addison's disease		Epilepsy
Asthma		Glaucoma
Bronchiectasis		Haemophilia
Cardiac failure	Hyperlipidaemia
Cardiomyopathy	Hypertension
Chronic obstructive pulmonary disorder	Hypothyroidism
Chronic renal disease	Multiple sclerosis
Coronary artery disease	Parkinson's disease
Crohn's disease	Rheumatoid arthritis
Diabetes insipidus	Schizophrenia
Diabetes mellitus types 1 & 2	Systemic lupus erythematosus
Dysrhythmias	Ulcerative colitis
HIV/Aids

“Medical schemes are required by law for pay for (what is the number? Check Council for Medical Schemes website) chronic conditions. Depending on the option you have chosen, your medical scheme will cover the relevant costs to your option. However, not all medication is covered by your scheme, which is why it is important that you consult your medical scheme and your doctor or specialist for more clarity in this regards.

Your medical scheme will guide you through the whole process of applying for chronic medication on your medical aid. These are the steps to follow and expect when applying for chronic medication on your medical scheme.

STEP 1: Always keep your membership card handy when contacting your medical scheme’s client service enquiry line (the telephone number is on your membership card).

STEP 2: A client service agent should be allocated to you. You will have to confirm your membership number and a form will be sent to you.

STEP 3: Complete the applicants section of the form and ask your doctor or specialist to complete the practitioners section. You will need to include your test results or specialists reports.

STEP 4 Send the completed application form together to your medical scheme (for processing.

STEP 5: If approved, a copy of your authorisation letter will be sent to you. If your request is declined, speak to a consultant about reapplying or confirm why you’ve been declined.