Plus Option
Chronic Care
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Effective 1 January 2026
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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: R83 300 per beneficiary or R171 600 per family |
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| 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 Click here for more information on the Medicine Risk Management Programme |
Accrues to the chronic condition limit of R83 300 per beneficiary or R171 600 per family | 100% of SEP plus agreed dispensing fee (subject to MRP and use of Pick n Pay Medical Scheme Pharmacy Network |