The Chronic Medication Benefit Explained

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Unlimited Medication For Chronic Conditions

6 Month Waiting Period
Single Benefit Level
Nationwide Network

Get unlimited chronic medication for 24 stated chronic conditions on our formulary.

Chronic cover is part of the Day-to-Day collection of benefits. Get cover for all of this and more.

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What is Covered?

The Chronic Medication benefit is designed to give you unlimited access to a wide range of medication prescribed by a doctor for certain chronic conditions. The formulary is extensive and favours generics where possible.

The benefit is unlimited which means that there is no limit as to how many times you may get medication (as long as it fits the prescription).

Note that your doctor may prescribe something that is not on the formulary which will not be covered. We do not interfere with the treatment plans of the medical providers.

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What is on the Formulary?

The formulary of medication is very extensive and favours generic medication.

The full list of medication available is not generally published online by the product administrator because it is extensive and is constantly updated as medical protocols change. If you are unsure or need to know about a specific medication then you are welcome to speak to us and we will assist.

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What Chronic Conditions are Covered?

The Chronic Disease List is actively maintained every year. That said, the latest 2021 list includes:

  • Addison’s Disease
  • Asthma
  • Bronchiectasis
  • Cardiac Failure
  • Cardiomyopathy
  • Chronic Obstructive Pulmonary Disease
  • Chronic Renal Failure
  • Coronary Artery Disease
  • Crohn’s Disease
  • Diabetes Insipidus
  • Diabetes Mellitus 1
  • Diabetes Mellitus 2
  • Dysrhythmia
  • Epilepsy
  • Glaucoma
  • HIV
  • Hyperlipidaemia
  • Hypertension
  • Hypothyroidism
  • Multiple Sclerosis
  • Parkinson’s Disease
  • Rheumatoid Arthritis
  • Systemic Lupus Erythematosus
  • Ulcerative Colitis
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Are there Co-Payments?

There are two cases where you may be required to make up a shortfall in a medication claim.

  • Dispensing fees
  • Co-payments

Dispensing fees are sometimes charged by a few pharmacists. We can't control this practice and do not cover dispensing fees. Fortunately, they are not large amounts.

Co-payments may apply to specific medication. The benefit is unlimited, meaning it can be used as often as is necessary, but certain medication is capped in the amount that is covered. Other medication is fully covered.

If you are unsure or would like to know about a specific medication then you can always ask your network doctor for guidance or speak to us.

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Answers to Your Questions

What does "unlimited" benefit mean?

When a health insurance benefit is "unlimited" it means that the benefit can be used as many times as you need without any specific annual limits.

The only conditions are that the claim or consultation is medically necessary.

Unlimited benefits are usually managed. This means that pre-authorisation is needed after a certain number of times that the benefit is used to ensure that it is you utilising the benefit and that you are getting the proper care that you deserve. You can find more details on the Network page.

What is the Medication benefit waiting period?

The waiting period on the Medication Benefit is 1 month.

This means that after the first month of your policy's inception, you can use the benefit and get access to formulary medication.

Where I can find the network pharmacists?

The Network page has all the information needed to find a provider on the network.

How are claims paid?

Claims are paid directly to the medical providers. You can find all the details on our claims page.

What are the age limits?

All new members joining a policy must be younger than 65 years on date of application.

Child dependants must be younger than 21 years before they will need to start their own policy.

However, if your child is still a registered full-time student and unmarried, then they may stay on the policy as a child dependant until they turn 26.

How many people can be on a policy?

Episodic health insurance policies can include:

  • you
  • your spouse/partner
  • up to 6 children