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Updated 09 February 2016

25 chronic conditions your scheme must cover

All medical schemes have to cover their members for the diagnosis, treatment and care of these 25 chronic illnesses.

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All medical schemes have to cover their members for the diagnosis, treatment and care of these 25 chronic illnesses below.

However, you should remember that a scheme does not have to pay for diagnostic tests that establish that you are suffering from a disorder that is NOT one of the 25 chronic ailments. But they will pay if the test comes back positive.

Which 25 illnesses are covered?

Addison's disease
Addison’s disease is a slowly progressive disease which occurs when the cortex (outside) of the adrenal glands are not functioning correctly.
 
Asthma
This condition where you struggle to breathe occurs when you can’t breathe out because your airways are constricted. Read more about asthma.
 
Bipolar mood disorder*
Bipolar disorder is a mood disorder characterised by extreme shifts in mood, energy and functioning.
 
Bronchiectatis
Bronchiectasis is a condition of permanent, abnormal dilatation of the major airways, with associated tissue destruction.
 
Cardiac failure
Heart failure means that your heart is unable to pump enough blood to your body’s tissues and organs to meet their needs.
 
Cardiomyopathy
The cardiomyopathies are a group of heart diseases that are defined by myocardial (heart muscle) dysfunction as the initial event
 
Chronic obstructive pulmonary disorder
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease characterised by obstruction of airflow that cannot be fully reversed with inhaler medications, called bronchodilators.
 
Chronic renal disease
In chronic renal failure (CRF) the kidney function decreases gradually but progressively. It is a lifelong condition that can lead to end-stage renal disease in some patients.
 
Coronary artery disease
Coronary artery disease (CAD), also known as coronary heart disease (CHD), occurs when the coronary arteries (the blood vessels that supply oxygen-rich blood to the heart muscle) gradually become narrowed or blocked by plaque (a combination of fatty material, calcium, scar tissue, and proteins) deposits.
 
Crohn's disease
Crohn's disease is a chronic inflammation of the bowel. Crohn's disease affects both sexes equally and has a seasonal variation. The most common symptom is abdominal pain.
 
Diabetes insipidus
Nephrogenic diabetes insipidus (NDI) is a rare disorder that is caused by large amounts of dilute urine produced by the nephrons, which are found in the kidneys.
 
Diabetes mellitus types 1 & 2
Type 1 diabetes is a disorder of sugar metabolism in which the pancreas is no longer able to produce insulin.

Type 2 diabetes is the most common variety of diabetes. It is a disorder of carbohydrate metabolism in which the body effectively becomes resistant to the hormone insulin.
 
Dysrhythmias
Arrhythmia, also called dysrhythmia, is a disturbance of the heart's normal rhythm. When the heart beats, the electrical impulses that cause it to contract must follow a precise pathway through the heart. Any interruption in these impulses can cause an arrhythmia. Arrhythmias cause the heart to pump blood less effectively.
 
Epilepsy
Epileptic seizures are sudden, often dramatic, "electrical storms" in the brain that range from very brief periods of "blanking out" to full-blown convulsions.
 
Glaucoma
Glaucoma is the name given to a group of conditions caused by increased intraocular (inside the eye) pressure, or IOP, resulting either from a malformation or malfunction of the eye's drainage system.
 
Haemophilia
Haemophiliacs have abnormal haemostasis, the ability to ‘stop bleeding’. Patients have a tendency to bleed easily after minor trauma or may even bleed spontaneously.
 
Hyperlipidaemia
High cholesterol, or hypercholesterolaemia, is a condition in which the amount of cholesterol in the blood exceeds normal values. This may be due to genetic or lifestyle factors.

Hypertension
Your blood pressure is the pressure within your blood vessels. Hypertension is a condition where the pressure within your arteries is consistently too high.
 
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not produce enough of the thyroid hormone, thyroxine.
 
Multiple sclerosis
Multiple sclerosis (MS) is a life-long chronic disease diagnosed primarily in young adults. During an MS attack, inflammation occurs in areas of the white matter of the central nervous system (nerve fibres that are the site of MS lesions) in random patches called plaques.
 
Parkinson's disease
Parkinson's disease belongs to a group of conditions called motor system disorders. It is the result of the loss of dopamine-producing brain cells.
 
Rheumatoid arthritis
Rheumatoid arthritis is a chronic condition characterised by persistent inflammation of the joints.
 
Schizophrenia
Schizophrenia is a serious disorder of the brain that affects how people think, feel and act.
 
Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is an inflammatory auto-immune disorder that can attack a single part of the body, or the whole body (systemic).
 
Ulcerative colitis
Ulcerative colitis is an inflammatory bowel disease. It causes inflammation and ulders in the lining of the large intestine.

* Will only be covered when an algorithm has been developed.
(Information from the Council for Medical Schemes)

 
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