Benefits & claims
Chronic disease benefits (CDL) explained
By Naledi Mokoena · 6 min read · Updated 24 June 2026
- CDL conditions
- 27 chronic conditions that are PMBs on every plan
- Coverage
- Must be paid in full when you use the DSP and formulary
- Registration
- Required before chronic claims are paid
- Funded from
- Risk pool, not your savings
Chronic disease benefits cover ongoing medicine and care for long-term conditions, and the 27 conditions on the Chronic Disease List (CDL) must be covered as Prescribed Minimum Benefits by every scheme. That means conditions like diabetes, asthma, hypertension and HIV are covered in full when you register and follow the rules.
Chronic cover is one of the most valuable parts of a medical aid, but it only works smoothly once you have registered the condition and are using the scheme's formulary and DSP. This guide explains how to get your chronic medicine paid in full.
The Chronic Disease List
The CDL is a list of 27 chronic conditions that every scheme must cover as PMBs, including asthma, chronic obstructive pulmonary disease, diabetes (types 1 and 2), epilepsy, hypertension, HIV, hypothyroidism, and several heart conditions. Because these are PMBs, even a basic hospital plan must cover them. Some plans cover additional non-CDL chronic conditions on top, but those extra conditions are not guaranteed by law.
Registering your condition
Chronic cover is not automatic. You (or your doctor) must apply to register the condition with the scheme. You will usually need:
- A diagnosis and prescription from your doctor
- The relevant chronic application form
- Sometimes supporting test results
Once registered, your approved chronic medicine is funded from the risk pool, so it does not eat into your day-to-day savings.
Formularies and DSPs
To be paid in full, chronic medicine usually has to be:
- On the scheme's formulary (its list of approved medicines for that condition)
- Dispensed by the scheme's designated service provider pharmacy
If you use a medicine off the formulary, you may face a co-payment, unless your doctor motivates that the formulary option is unsuitable. Using a non-DSP pharmacy can also trigger a co-payment. See designated service providers.
If cover is refused or limited
Because CDL conditions are PMBs, the scheme must cover appropriate treatment in full when you follow the protocol. If a scheme refuses or imposes a limit on valid PMB chronic care, raise a written dispute, and if needed complain to the Council for Medical Schemes at medicalschemes.co.za. Keep your prescriptions and clinical reports as evidence.
Frequently asked questions
What are chronic disease benefits?
They cover ongoing medicine and care for long-term conditions. The 27 Chronic Disease List conditions are Prescribed Minimum Benefits, so every scheme must cover them in full when you register and follow the rules.
Which chronic conditions are covered by law?
The 27 CDL conditions, including asthma, diabetes, hypertension, epilepsy, HIV and several heart and thyroid conditions. These must be covered on every plan, including hospital plans, as PMBs.
How do I register a chronic condition?
Apply to the scheme with your doctor's diagnosis, prescription, the chronic application form, and any required test results. Once registered, approved chronic medicine is funded from the risk pool.
Why am I paying in for my chronic medicine?
Usually because the medicine is off the scheme's formulary or you used a non-DSP pharmacy. Switching to a formulary option or DSP pharmacy, or getting a doctor's motivation, often removes the co-payment.
Does a hospital plan cover chronic medicine?
It covers the 27 CDL conditions because they are PMBs. Non-CDL chronic medicine is usually not covered on a hospital plan. Register the condition and use the scheme's DSP.
Is chronic medicine taken from my savings?
No. Once your CDL condition is registered, approved chronic medicine is paid from the risk pool, not your medical savings account, which keeps your savings for day-to-day needs.
