06 July 2011

List of chronic diseases

All medical schemes are obligated to provide cover for the 'diagnosis and medication' of the following conditions.


All medical schemes are required to provide cover for the 'diagnosis, medical management and medication' of the following conditions.

A list of chronic diseases

  • Asthma
  • Bipolar mood disease
  • Brochiectasis
  • Cardiac failure
  • Cardiomyopathy
  • Chronic obstructive pulmonary disease
  • Chronic kidney disease
  • Coronary artery disease
  • Crohn's disease
  • Diabetes insipidus
  • Diabetes mellitus (type 1 and type 2)
  • Dysrhythmia (irregular heartbeat)
  • Epilepsy
  • Glaucoma
  • Haemophilia
  • HIV
  • Hyperlipidaemia (high cholesterol)
  • Hypertension (high blood pressure)
  • Hypothyroidism (inactive thyroid gland)
  • Multiple sclerosis
  • Parkinson's disease
  • Rheumatoid arthritis
  • Schizophrenia
  • Systemic lupus erythematosis
  • Ulcerative colitis

No exclusions
Medical schemes often have a list of conditions – such as cosmetic surgery – for which they will not pay, or circumstances – such as travel costs and examinations for insurance purposes – under which a member has no cover. These are called exclusions. Exclusions, however, do not apply to PMBs. If you contract septicaemia after cosmetic surgery, for example, your scheme has to provide healthcare cover for the septicaemia part because septicaemia is a PMB. (Cosmetic surgery remains exclusion.) PMBs are concerned about the diagnosis; it doesn’t matter how you got the condition.

Information from the Council of Medical Schemes


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