Benefits & claims

Chronic disease benefits (CDL) explained

By MedicalAidZA editorial team · 6 min read · Updated 29 September 2026

CDL conditions: 26 on the CMS PMB page; a 17 August 2026 CMS slide says 27
Applies to: Every registered scheme and every plan, including hospital plans
Registration: Required before chronic medicine is paid
Paid in full when: You use the scheme's formulary and designated service provider
Funded from: The risk pool, not your medical savings

Chronic disease benefits pay for ongoing medicine and care for long-term conditions, and the conditions on the Chronic Disease List (CDL) must be covered by every medical scheme as Prescribed Minimum Benefits (PMBs). That means conditions such as diabetes, asthma, hypertension and epilepsy are paid in full once you register and follow the scheme's rules.

Chronic cover is not automatic. You have to register the condition, and the scheme decides which medicine (its formulary) and which pharmacy (its designated service provider) will be paid without a co-payment.

The Council for Medical Schemes (CMS) says there are 26 chronic conditions in the PMBs. A CMS presentation dated 17 August 2026 says 27. This guide explains the list, the registration steps and the usual reasons people pay in.

What the Chronic Disease List is

The CDL is the list of chronic conditions that the law treats as PMBs. Because they are PMBs, every benefit option must pay the diagnosis, treatment and care costs in full, without co-payments or deductibles, so even a basic hospital plan must cover them. See prescribed minimum benefits.

The count is not settled across CMS sources: the CMS PMB page says 26 chronic conditions, a CMS slide from 17 August 2026 says 27, and the consolidated Regulations on the CMS site name 25 conditions. Some of the difference is probably how HIV and later additions are counted. HIV is on the list.

Rather than rely on a number, ask your scheme to confirm that your condition is a CDL condition.

The conditions named in the Regulations

The Regulations name these chronic conditions:

Addison's disease
Asthma
Bipolar mood disorder
Bronchiectasis
Cardiac failure and cardiomyopathy
Chronic renal disease
Chronic obstructive pulmonary disease
Coronary artery disease
Crohn's disease
Diabetes insipidus
Diabetes mellitus types 1 and 2
Dysrhythmias
Epilepsy
Glaucoma
Haemophilia
Hyperlipidaemia
Hypertension
Hypothyroidism
Multiple sclerosis
Parkinson's disease
Rheumatoid arthritis
Schizophrenia
Systemic lupus erythematosus
Ulcerative colitis

HIV is also on the current Chronic Disease List. Cover applies to the condition as defined, at the treatment level the PMB rules set, not to every drug or every complication.

How to register a chronic 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 scheme's chronic application form.
Sometimes supporting test results.

Once the scheme approves it, your chronic medicine is paid from the risk pool, so it does not eat into your day-to-day savings. See medical savings accounts for how savings work. Register as soon as you are diagnosed, and again for each new condition, because approval is per condition.

Formularies and DSP pharmacies

To be paid in full, chronic medicine usually has to be:

On the scheme's formulary, its list of approved medicines for the condition.
Dispensed by the scheme's designated service provider (DSP) pharmacy.

The Regulations allow schemes to use formularies, treatment protocols and pre-authorisation for PMBs. If you take a medicine that is not on the formulary, you may face a co-payment, unless your doctor motivates in writing why the formulary options do not suit you.

Using a non-DSP pharmacy can also trigger a co-payment. The CMS says that if you choose not to use the DSP, you may have to pay a percentage co-payment or the difference between the DSP's tariff and what the other provider charged. No co-payment applies if you obtained the service involuntarily, for example when there is no DSP within reasonable reach of your home or work. See designated service providers.

Chronic conditions that are not on the list

A long-term condition that is not on the CDL is not guaranteed by law. Some plans cover extra chronic conditions on top of the list, and others cover none. If you have a non-CDL condition, check the plan's chronic benefit table before you join, including the annual limit and which medicines are included.

Hospital plans normally cover chronic medicine for CDL conditions only. Non-CDL chronic medicine is usually not covered on a hospital plan. See hospital plans explained and what does medical aid cover.

Joining a scheme with a chronic condition

Waiting periods and penalties matter here. An open scheme must accept you, but it can still apply waiting periods. If you had no scheme cover for at least 90 days, it can apply up to a 3-month general and a 12-month condition-specific waiting period. Where you had cover recently and the break is under 90 days, the Act bars waiting periods on PMB treatment. If you are 35 or older with no earlier cover, late joiner penalties can also apply.

Ask each scheme in writing how it would treat your condition before you sign. See waiting periods and exclusions and late joiner penalty.

If cover is refused or limited

Because CDL conditions are PMBs, the scheme must pay for appropriate treatment in full when you follow the protocol. If it refuses or limits valid PMB chronic care:

Ask for the reason in writing.
Send your doctor's motivation, prescriptions and clinical reports.
Use the scheme's dispute process, with our chronic medication application letter.
If it is still refused, complain to the CMS. See how to complain to the CMS.

Frequently asked questions

What are chronic disease benefits?

They pay for ongoing medicine and care for long-term conditions. The conditions on the Chronic Disease List are Prescribed Minimum Benefits, so every scheme must cover them in full when you register and follow its rules.

Which chronic conditions are covered by law?

Those on the Chronic Disease List, which include asthma, diabetes, hypertension, epilepsy, HIV and several heart and thyroid conditions. The CMS counts 26 conditions, while one 2026 CMS slide says 27, so confirm yours with the scheme.

How do I register a chronic condition?

Apply to the scheme with your doctor's diagnosis and prescription, the chronic application form, and any test results it asks for. Once approved, your chronic medicine is paid from the risk pool.

Why am I paying a co-payment on chronic medicine?

Usually because the medicine is not on the formulary or you used a non-DSP pharmacy. Switching to a formulary medicine or the DSP pharmacy, or getting your doctor to motivate, often removes the co-payment.

Does a hospital plan cover chronic medicine?

It must cover CDL conditions, because they are PMBs and every benefit option pays them in full. Chronic medicine for conditions not on the list is usually not covered on a hospital plan.

Is chronic medicine taken from my savings?

Not for a registered CDL condition. Approved chronic medicine is paid from the risk pool, not your medical savings account, which keeps your savings for day-to-day costs.

Is HIV covered as a chronic condition?

Yes. HIV is on the Chronic Disease List, so treatment and related care is a PMB when you register and follow the scheme's protocol. Registration matters, because it is how the scheme approves your medicine.

Can I be refused chronic cover when I join?

An open scheme must accept you but can apply waiting periods, and up to 12 months condition-specific waiting can apply if you had no cover for at least 90 days. Where the break was under 90 days, PMB treatment cannot be made to wait.