7 Facts about your Chronic Illness Benefit cover!

Fact 1 | I have just been diagnosed with a chronic condition, how do I get covered?

Get the latest application form on www.bemas.co.za > Application forms. For a condition to be covered from the Chronic Illness Benefit, there are certain benefit entry criteria that the member's condition needs to meet.

Complete a Chronic Illness Benefit application form with your doctor and submit it for review. If we approve funding for your condition from the Chronic Illness Benefit, the benefit covers certain procedures, tests and consultations for the diagnosis and ongoing management of the 27 Chronic Disease List (CDL) conditions, in line with Prescribed Minimum Benefits.

We will pay your approved chronic medicine in full up to the Society Rate if it is on the BMW Employees Medical Aid Society medicine list (formulary).

Fact 2 | What if my approved medicine is not on the medicine list?

If your approved chronic medicine is not on the medicine list, we will pay your chronic medicine up to a set monthly Chronic Drug Amount (CDA) for each medicine category.

Fact 3 | What happens if I have a combination of medicines in the same medicine category?

If you use a combination of medicines in the same medicine category, where one is on the list and the other is not, we pay for the medicine up to the one monthly Chronic Drug Amount for that medicine category.

Fact 4 | What are the 27 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions?

Addison's disease
Asthma
Bipolar mood disorder
Bronchiectasis
Cardiac failure
Cardiomyopathy
Chronic obstructive pulmonary disease (COPD)
Chronic renal disease
Coronary artery disease
Crohn's disease
Diabetes insipidus
Diabetes mellitus type 1
Diabetes mellitus type 2
Dysrhythmia
Epilepsy
Glaucoma
Haemophilia
HIV and AIDS *
Hyperlipidaemia
Hypertension
Hypothyroidism
Multiple sclerosis
Parkinson's disease
Rheumatoid arthritis
Schizophrenia
Systemic lupus erythematosus
Ulcerative colitis * Managed through the HIVCare Programme

Fact 5 | What do I need to do to make sure that my treatment is paid from the correct benefit?

Your healthcare professional needs to submit claims with the relevant ICD-10 diagnosis code(s). Please ask your healthcare professional to include your ICD-10 diagnosis code(s) on the claims they submit and on the form that they complete when they refer you to pathologists and radiologists for tests. This will allow pathologists and radiologists to include the relevant ICD-10 diagnosis code(s) on the claims they submit to ensure that we pay your claims from the correct benefit.

Fact 6 | Are there any other conditions covered by the Society, apart from the 27 PMB CDL conditions?

Yes, the following are Additional Disease List (ADL) conditions which the Society covers. However, there is no medicine list for these conditions. We pay approved medicine for these conditions up to the monthly Chronic Drug Amount (CDA).

Ankylosing spondylitis
Beh�et's disease
Chronic rhinitis
Cystic fibrosis
Delusional disorder
Dermatopolymyositis
Gastro-oesophageal reflux disease
Generalised anxiety disorder
Huntington's disease
Isolated growth hormone deficiency in children younger than 18 years
Major depression
Motor neurone disease
Muscular dystrophy and other inherited myopathies
Myasthenia gravis
Obsessive-compulsive disorder
Osteoporosis
Paget's disease
Panic disorder
Polyarteritis nodosa
Post-traumatic stress disorder
Psoriatic arthritis
Pulmonary interstitial fibrosis
Sj�gren's syndrome
Systemic sclerosis

Claims for all chronic medicine add up to a yearly limit. We will only continue funding medicine for approved Chronic Disease List (CDL) conditions once you have reached the yearly limit.

Fact 7 | Where do I find a healthcare professional?

You can find a healthcare professional on www.bemas.co.za > Find a healthcare professional. You can then search for a healthcare professional who is in our network.