Getting the most from your Chronic Disease Benefit

Some of us are diagnosed with chronic diseases like diabetes, depression or epilepsy, for which we need treatment on an ongoing basis. Without these specific medications, our lives  and well-being could potentially be in danger.

 

Fedhealth has a comprehensive Chronic Disease Benefit that cares for chronic patients and their specific needs.

 

This Chronic Disease Benefit covers 51 chronic conditions on Maxima Plus and Maxima Exec, 39 chronic conditions on Maxima Standard, Maxima StandardNet and the 25 Prescribed Minimum Benefit (PMB) conditions on Maxima Basis, Maxima Saver, Maxima EntrySaver, Maxima Core and Maxima EntryZone.

 

Formularies and DSP

The Scheme uses formularies and a Designated Service Provider (DSP) to manage the cost and ensure accessibility and appropriate level of care for all our members.

 

A formulary is an approved list of medication for each of the chronic conditions covered by the Scheme. These formularies do not compromise the quality of healthcare the member receives in any way, and are subject to the Medicine Price List (MPL). Fedhealth’s Designated Service Provider (DSP) is the Medi-Rite group of pharmacies, located in Checkers and Shoprite supermarkets. Use of the DSP is dependent on the option choice.

 

Co-payments

If the option requires the use of Fedhealth’s DSP (Medi-Rite pharmacies), or is subject to one of Fedhealth’s formularies, and you choose to use a service provider of choice or out-of-formulary medication instead, it will mean a 40% co-payment on the cost of the medication. If the condition is a PMB condition, your co-payment will not be refundable from Savings.

 

Medicine Price List (MPL)

Medication will be covered at the MPL rates up to the limits as specified on the chosen option. MPL is a reference price list that benchmarks each product against generically similar products. It does not restrict your choice, but limits the amount that the Scheme will refund

for each product. The MPL reference price is set at a level to ensure that a number of medicines will be available without any co-payment.

 

Treatment guidelines

The Scheme has established treatment guidelines for the 25 PMB chronic conditions to ensure that our members receive appropriate treatment for their conditions. You will receive details of the treatment guidelines once you register for one of these conditions, and the Scheme has received your first claim relating to the condition.

 

For more information about chronic conditions covered by Fedhealth, and how to apply for the Chronic Medicine Benefit, click here.

 With the Chronic Disease Benefit, Fedhealth is looking after members with chronic conditions     by ensuring they get the medication they need to thrive, every day.