Bonitas: Chronic Conditions

CDL – CHRONIC DISEASE LIST

• By law, each scheme must cover the medicine and treatment for 27 Chronic Diseases. These are listed below.
• For every CDL condition there is a basic treatment plan. This can include consultations, pathology and radiology and medicine.
• Each Scheme must pay for this treatment plan out of risk, without forcing you to have out-of-pocket expenses.

PAYMENT FOR CHRONIC MEDICINE

• However, each Scheme is allowed to:
  • set its own protocols,
  • insist that you to use Designated Service Providers (DSP) and
  • enforce a pre-set list of acceptable medicines per each condition.
• If you deviate from any of these, you might incur out-of-pocket expenses
• Bonitas has a set reference price for each medicine, and will not pay more than that price for a medicine

FORMULARIES

• A formulary is a list of medicines that a Scheme will pay for, per condition
• Using a medicine that is not on the formulary will usually result in a co-payment
• Bonitas has two formularies: the “restricitive formulary” and the “comprehensive formulary“. Only the BonComprehensive and Standard options use the more inclusive “Comprehensive formulary”.
• Both formularies include alternative products that will not require a co-payment to be made, so if you do not wish to incur any co-payments, discuss alternative therapies with your treating doctor

CDL and non-CDL Lists

Green indicates that coverage is provided for the listed condition.

		All the plans
1	Addison’s Disease	Yes
2	Asthma	Yes
3	Bipolar Mood Disorder	Yes
4	Bronchiectasis	Yes
5	Cardiomyopathy	Yes
6	Chronic Renal Failure	Yes
7	Chronic Obstructive Pulmonary Disease	Yes
8	Congestive Heart Failure	Yes
9	Coronary Artery Disease	Yes
10	Crohn’s Disease	Yes
11	Diabetes Insipidius	Yes
12	Diabetes Type 1	Yes
13	Diabetes Type 2	Yes
14	Dysrhythmia	Yes
15	Epilepsy	Yes
16	Glaucoma	Yes
17	Haemophilia	Yes
18	HIV/AIDS	Yes
19	Hyperlipidaemia	Yes
20	Hypertension	Yes
21	Hypothyroidism	Yes
22	Multiple Sclerosis	Yes
23	Parkinson’s Disease	Yes
24	Rheumatoid Arthritis	Yes
25	Schizophrenia	Yes
26	Systemic Lupus	Yes
27	Ulcerative Colitis	Yes

		Classic	Comp.	Fit	Save	Primary	Std	Essential
non-CDL	Acne	No	Yes	No	No	No	Yes	No
non-CDL	ADD (5-18yrs)	No	Yes	No	No	No	Yes	No
non-CDL	Allergic Rhinitis	No	Yes	No	No	No	Yes	No
non-CDL	Alzheimers	Yes	No	No	No	No	No	No
non-CDL	Ankylosing Spondylitis	Yes	Yes	No	No	No	Yes	No
non-CDL	Barrett’s Oesophagus	Yes	Yes	No	No	No	Yes	No
non-CDL	Behcet’s Disease	Yes	Yes	No	No	No	Yes	No
non-CDL	Deep Vein Thrombosis	No	Yes	No	No	No	No	No
non-CDL	Depression	Yes	Yes	No	No	No	Yes	No
non-CDL	Dermatisis	No	Yes	No	No	No	Yes	No
non-CDL	Dermatomyositis	No	Yes	No	No	No	No	No
non-CDL	Eczema	Yes	Yes	No	No	No	Yes	No
non-CDL	GORD	Yes	Yes	No	No	No	Yes	No
non-CDL	Generalised Anxiety Disorder	Yes	Yes	No	No	No	No	No
non-CDL	Gout	Yes	Yes	No	No	No	Yes	No
non-CDL	Huntington’s Disease	No	Yes	No	No	No	No	No
non-CDL	Hypoparathyroidism	Yes	Yes	No	No	No	No	No
non-CDL	Myasenthia Gravis	No	Yes	No	No	No	No	No
non-CDL	Narcolepsy	No	Yes	No	No	No	Yes	No
non-CDL	Neuropathy	No	Yes	No	No	No	No	No
non-CDL	OCD	Yes	Yes	No	No	No	Yes	No
non-CDL	Osteoperosis	Yes	Yes	No	No	No	No	No
non-CDL	Paget’s Disease	Yes	Yes	No	No	No	No	No
non-CDL	Panic Disorder	Yes	Yes	No	No	No	Yes	No
non-CDL	Pemphigus	No	Yes	No	No	No	No	No
non-CDL	Polyarteritis Nodosa	Yes	Yes	No	No	No	No	No
non-CDL	PTSD	Yes	Yes	No	No	No	Yes	No
non-CDL	Psoriatric Arthritis	No	Yes	No	No	No	No	No
non-CDL	Pulmonary interstitial fibrosis	Yes	Yes	No	No	No	No	No
non-CDL	Scleroderma	Yes	No	No	No	No	No	No
non-CDL	Tourette’s Syndrome	Yes	Yes	No	No	No	Yes	No
non-CDL	Zollinger-Ellison Syndrome	Yes	Yes	No	No	No	Yes	No