Chronic Illness Cover For Retirees

Your Guaranteed Cover.

If you are managing a chronic condition — or if there’s a reasonable chance you will develop one in retirement — this chapter is one of the most important you will read.

Chronic illness cover is complex, inconsistent across schemes, and poorly understood by most members.

Getting it wrong can mean paying thousands of rands per month for medication that should be covered.

This series was written specifically for you — whether you’re five years from retirement or already enjoying your years of freedom. It is practical, plain-spoken, and South African. No jargon and no advice. Just plain information you want to know for your own well-being.

This is part 6 about: Chronic Illness Cover for Retirees.

Please read the DISCLAIMER from the link near the bottom of the page.

The Chronic Disease List (CDL).

Every medical aid scheme in South Africa is required by law to cover 27 specific chronic conditions on what is known as the Chronic Disease List.

This forms part of the Prescribed Minimum Benefits discussed in Post Number 1.

If your condition is on this list, your scheme must pay for the treatment — but only if you are formally registered on the CDL through your scheme, and only for approved treatment protocols.

THE 27 CDL CONDITIONS INCLUDE:

Addison’s disease,
Asthma,
Bipolar mood disorder,
Bronchiectasis,
Cardiac failure,
Cardiomyopathy,
COPD,
Chronic renal disease,
Coronary artery disease,
Crohn’s disease,
Diabetes insipidus,
Diabetes mellitus Type 1, and
Diabetes mellitus Type 2,
Dysrhythmias,
Epilepsy,
Glaucoma,
Haemophilia,
Hyperlipidaemia,
Hypertension,
Hypothyroidism,
Multiple sclerosis,
Parkinson’s disease,
Rheumatoid arthritis,
Schizophrenia,
Systemic lupus,
Erythematosus, and
Ulcerative colitis.

How to Register on the CDL.

Simply having a diagnosis is not enough. You must actively register your condition with your medical aid scheme.

Your doctor needs to complete a CDL registration form, confirming your diagnosis and the medication you require.

Once approved, your chronic medication is covered from your CDL benefit — separate from your medical savings account.

If you are not registered and your doctor simply prescribes your chronic medication, it may be deducted from your savings account instead.

When Your Scheme Says ‘No’ — Off-Formulary Medication.

Here is where many retirees run into trouble. Your scheme’s CDL cover only applies to medications on their approved formulary — their list of accepted drugs.

If your doctor prescribes a brand-name medication, a newer drug, or a treatment not on your scheme’s formulary, you may be required to pay for it yourself or accept a generic substitute.

Some schemes are stricter than others, and formularies differ significantly between plans.

⚠ WATCH OUT: Never assume your chronic medication is covered just because your condition is on the CDL. Call your scheme’s chronic care line, confirm that your specific medication is on the formulary, and ask what the approved dosage is. Do this every time your doctor changes your prescription.

Managing Chronic Costs in Retirement.

Use your scheme’s designated pharmacies — they are contracted to dispense CDL medication at no cost to you.
Ask your doctor about generic alternatives to brand-name drugs. The active ingredient is the same; the cost is often 50–70% less.
Order three-month supplies at a time from your scheme’s mail-order pharmacy where available — this is often cheaper and more convenient.
If you have multiple chronic conditions, consider a higher-tier plan — the CDL benefit savings may outweigh the premium difference.
Keep a personal record of all your CDL registrations, approved medications, and annual reviews.

Next…

The next post in the series will explain:
Frail Care, Assisted Living & Long-Term Care.
As you will want to know more, all you have to do is to subscribe to this series below.
You may unsubscribe at any given time from future posts.

PS: We are not medical aid brokers or financial advisors and will not try to sell you any medical cover. This series is for informational purposes only.

DISCLAIMER.