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When is a condition ‘chronic’ and how can you get access to chronic benefits?

When observing changes in your health, you would hopefully see your doctor. If your doctor suspects a condition like high blood pressure, asthma, depression, etc. you might have to take medication.

At this stage, you might ask yourself how you are covered for the treatment of your condition, especially if you would need to take medication for a long time or even for the rest of your life.

The doctor might first prescribe medication for a three-month period to assess how you fair on the dose and on the specific medication. If you need to take any medication for more than three months, the Scheme will consider the condition to be chronic. If your condition is on the list of covered chronic conditions, the treatment will be funded from a dedicated chronic benefit and not from your day-to-day benefits or your Medical Savings Account (Managed Care Plan only). You do not have to wait for the third month to activate the chronic benefits if the diagnosis is already confirmed and your doctor knows the treatment is long term in nature.

So, what is the next step? Your doctor or the pharmacist must phone our call centre to register your condition. In some instances, we would need pathology tests confirming the diagnosis and/or forms with specific clinical information to be completed by your healthcare provider, as certain clinical criteria (for conditions such as rheumatoid arthritis) will apply to qualify for funding.

Once all of this is done, and we have confirmed that you qualify for chronic benefits, the condition will be registered, and you will receive an email or letter confirming the registration and period of registration if relevant. If specifically mentioned, you might have to reapply as indicated to continue the benefit. In other cases, you will not have to reapply and chronic authorisations will be continued every year. Our Call Centre team can always help you understand what is funded and what you need to do to qualify for the correct benefits.

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