The Chronic Medication Benefit Explained

Unlimited medication for chronic conditions


Unlimited Medication for Chronic Conditions

Get access to unlimited chronic medication on a formulary for 24 stated chronic conditions.

Chronic Medication is a standard benefit on the Day-to-Day Plan. Get to a doctor, get medication & get well. All for for a single premium.

6 Month Waiting Period
Single Benefit Level
Included in Day-to-Day Plan

How Does It Work?

Find answers to the most common questions about this benefit. Browse our Help pages and Blog posts for more information.

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 specific 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.

What is on the Formulary?

The approved 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 regularly 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.

What Chronic Conditions are covered?

The Chronic Disease List is actively maintained every year. The current list includes 24 stated conditions:

  • 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

What is the waiting period?

There is a 6 month waiting period before any new member on a policy can claim under this benefit.

What does "unlimited" benefit mean?

The benefit is "unlimited" which means that, in general, there is no limit as to how many times you may claim for medication (as long as it fits the prescription and the formulary).

Are there Co-Payments?

The benefit is unlimited but it is not uncapped. 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 usually expensive.

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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