How Bestmed covers chronic conditions

Bestmed medical aid scheme >> Chronic conditions

CDL – Chronic Disease List

  • To see how each Bestmed plan covers chronic conditions, see each individual plan and its benefits
  • Overall, by law, each plan must cover the medicine and treatment for 27 Chronic Diseases which appear on the chronic disease list. These are listed below, and are known as PMBs (Prescribed Minimum Benefits).
  • For each of these 27 chronic conditions there is a basic treatment plan as set out by Bestmed. This can include consultations, pathology and radiology and has an annual limit. The cost for this treatment is paid for by Bestmed, and not out of any day-to-day funds. Once the annual limit is reached, further claims will be covered from normal Day-to-Day or Acute benefits.
  • In addition to the 27 chronic conditions that must be covered, some of Bestmed plans also cover other chronic conditions. These are also listed below.
  • You must register with Bestmed for all chronic benefits.
  • A formulary is the list of medicines that Bestmed will cover, for the treatment of the listed chronic conditions. There is an out-of-pocket co-payment for non-formulary medicines.
  • A generic reference price is a maximum set price Bestmed will pay for a generic medicine of specific dosage. You can use the original medicine, and pay the difference, or use the generic medicine. This applies to both formulary and non-formulary medicine.
  • Using any of the 1,300 Bestmed preferred pharmacies will ensure no co-payments for dispensing fees.

CDL and non-CDL Lists

Green indicates that coverage is provided for the listed condition.

Beat
Pace Pulse
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CDL 1 Addison’s Disease Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 2 Asthma Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 3 Bipolar Mood Disorder Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 4 Bronchiectasis Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 5 Cardiomyopathy Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 6 Chronic Renal Failure Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 7 COPD Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 8 Congestive Heart Failure Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 9 Coronary Artery Disease Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 10 Crohn’s Disease Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 11 Diabetes Insipidius Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 12 Diabetes Mellitus Type 1 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 13 Diabetes Mellitus Type 2 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 14 Dysrhythmia Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 15 Epilepsy Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 16 Glaucoma Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 17 Haemophilia Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 18 HIV/AIDS Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 19 Hyperlipidaemia Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 20 Hypertension Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 21 Hypothyroidism Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 22 Multiple Sclerosis Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 23 Parkinson’s Disease Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 24 Rheumatoid Arthritis Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 25 Schizophrenia Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 26 Systemic Lupus Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
CDL 27 Ulcerative Colitis Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
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Pace Pulse
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non-CDL Acne No No Yes Yes Yes Yes Yes Yes No Yes
non-CDL ADD No No Yes Yes Yes Yes Yes Yes No Yes
non-CDL Allergic Rhinitis No No Yes Yes Yes Yes Yes Yes No Yes
non-CDL Alzheimer’s No No No No No Yes Yes Yes No Yes
non-CDL Ankylosing Spondylitis No No No No No Yes Yes Yes No Yes
non-CDL Benign Prostatic Hypertrophy No No No No No Yes Yes Yes No Yes
non-CDL Aplastic Anaemia No No No No No Yes Yes Yes No Yes
non-CDL Chronic Anaemia No No No Yes Yes Yes Yes Yes No Yes
non-CDL Collagen Diseases No No No No No Yes Yes Yes No Yes
non-CDL Cushing’s Diseases No No No No No Yes Yes Yes No Yes
non-CDL Cystic Fibrosis No No No No No Yes Yes Yes No Yes
non-CDL Dermatomyositis No No No No No Yes Yes Yes No Yes
non-CDL Eczema No No Yes Yes Yes Yes Yes Yes No Yes
non-CDL Endometriosis No No No Yes Yes Yes Yes Yes No Yes
non-CDL Fibrosing Alveolitis No No No No No No No Yes No Yes
non-CDL GORD No No No No No Yes Yes Yes No Yes
non-CDL Gout Prohylaxis No No No Yes Yes Yes Yes Yes No Yes
non-CDL Graves Disease No No No Yes No Yes Yes Yes No Yes
non-CDL Hyperthyroidism No No No No No No No Yes No Yes
non-CDL Hypophyseal Adenoma No No No No No Yes Yes Yes No Yes
non-CDL Hypopituitarism No No No No No No No Yes No Yes
non-CDL Idiopathic Thrombocytopenic Pupura No No No No No No No Yes No Yes
non-CDL Major Depression No No No Yes Yes Yes Yes Yes No Yes
non-CDL Menopause No No No Yes No Yes Yes Yes No Yes
non-CDL Migraine Prohylaxis No No Yes Yes Yes Yes Yes Yes No Yes
non-CDL Motor Neuron Disease No No No No No No No Yes No Yes
non-CDL Muscular Dystrophy No No No No No No No Yes No Yes
non-CDL Myasenthia Gravis No No No No No No No Yes No No
non-CDL Neuropathy No No No No No No No Yes No Yes
non-CDL OCD No No No Yes No Yes Yes Yes No Yes
non-CDL Osteoathritis No No No No No Yes Yes Yes No Yes
non-CDL Osteoperosis No No No No No Yes Yes Yes No Yes
non-CDL Paget’s Disease No No No No No Yes Yes Yes No Yes
non-CDL Polyarteritis Nodosa No No No No No No No Yes No No
non-CDL Polycystic Ovarian Disease No No No Yes Yes Yes Yes Yes No Yes
non-CDL Paraplegia/Quadriplegia No No No Yes No Yes Yes Yes No Yes
non-CDL Psoriasis No No No No No Yes Yes Yes No Yes
non-CDL Psoriatic Arthrisis No No No No No No No Yes No No
non-CDL Pulmonary Embolism No No No Yes No Yes Yes Yes No Yes
non-CDL Pulmonary Interstitial Fibrosis No No No No No No No Yes No No
non-CDL Scleroderma No No No No No No No Yes No No
non-CDL Sjorgen’s Disease No No No No No No No Yes No No
non-CDL Stroke No No No Yes No Yes Yes Yes No Yes
non-CDL Trigerminal Neuralgia No No No No No No No Yes No No
non-CDL Urinary Incontinence No No No No No Yes Yes Yes No Yes
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