Chronic medicine

As a member of SAB Medical Aid, you have cover for 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. These are chronic conditions that all medical scheme members must be covered for, regardless of the Option they choose. This cover helps ensure you can access essential healthcare services, including diagnosis, treatment and ongoing care for these conditions.

Once we approve cover for your condition, you can access approved medicine, medical items and a treatment basket designed to help manage your condition. Click here to view the document that lists the procedures, investigations and consultations we cover for your approved PMB CDL condition/s. You also have cover for up to four GP consultations each year related to your registered PMB CDL condition(s).

The number of tests and consultations available to you depends on when your condition is approved during the year. If your approved condition qualifies for cover from more than one treatment basket, we will fund the basket that provides the greatest number of tests or procedures.

To help ensure your PMB CDL claims are paid from the correct benefit, your healthcare professional must include the correct ICD-10 (diagnosis) code on all claims and referral forms. Please remind your doctor to include these codes when submitting claims or referring you for pathology or radiology tests. This helps us process and pay your claims from the correct benefit.

If you need more cover than what is included in the treatment basket, your doctor can apply for additional funding for extra tests, procedures or consultations that are medically necessary. To do this, they must complete and submit a Request for Additional Cover for Approved Chronic Disease List Conditions form for review. Please note that applying does not guarantee approval for additional cover.

If you were recently diagnosed with and approved for cover for a PMB CDL condition, the costs related to diagnosing your condition may be paid from your Chronic Benefit instead of your other available benefits, provided your membership was active when the diagnosis was made.

In addition to PMB CDL cover, the Comprehensive Option includes cover for certain chronic conditions that are not part of the PMB list. These are called extended chronic conditions. Members on the Essential Option do not have access to these extended chronic conditions. Click here to see which additional chronic conditions are covered.

Useful resources to help you manage your Chronic Benefit cover

• View the Prescribed Minimum Benefit (PMB) treatment baskets to see the tests, procedures and consultations covered for approved chronic conditions
• If you require cover beyond the approved treatment basket, your doctor can complete a Request for additional cover for Approved Chronic conditions form and submit it for review.
• For more information about chronic condition covers on your Option, refer to the 2026 SABMAS Benefit Guide.

Need cover for a chronic condition?

Ask your doctor to contact our Customer Care Centre on 0860 002 133 to register your condition and apply for chronic cover. Our team will guide the process and assess the application as quickly as possible.