Chronic Medication Program

This programme is managed by the MomentumTYB Benefit Management (PBM) team who will evaluate all applications for the chronic medication benefit to ensure that they are in line with the scheme’s accepted protocols. All new chronic applicants will need to complete the Suremed Chronic Medication Application form which may be obtained by calling (041) 395 4482 or e-mailing chronic@suremedhealth.co.za . Any queries regarding chronic medication can also be answered through these contacts.

Chronic Medication is defined as life sustained medication for a chronic condition.

MomentumTYB Chronic Medication Programme will ensure that the medicines prescribed are:

  • Appropriate
  • Necessary
  • Safe
  • Cost effective

How do you apply for Chronic Medication?
In order to qualify for the benefit you need to apply by submitting your application form to MomentumTYB for approval. Application forms can be obtained from your broker, the website or from MomentumTYB. Ask your doctor for assistance in completing the form. Please ensure that your membership number is filled in on the form and that you and your doctor have signed the form.

How will you know that your chronic medication has been approved?
You will receive a letter detailing the medicines that have been approved, once the clinical team has assessed the application. The approval letter should be given to your medicine supplier with a matching valid prescription. Only medicines that have been approved by MomentumTYB will be paid for.

NB: The scheme may also require members to register and participate in a recognised Disease Management Programme for chronic disease conditions to enjoy this benefit.

CHRONIC DISEASE LISTING

Chronic medication for the following disease listing are considered as Prescribed Minimum Benefits (PMB’s) and referred to as Chronic Disease Listing (CDL) in your benefit summary.

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

The scheme pays for these medicines according to the Formulary. Chronic medication for ailments not on the CDL list is covered by your acute medication benefit.

Please note that the Challenger Option has an additional 19 diseases included in the list of Chronic Conditions:

  • Ankylosing spondylitis
  • Cushing’s disease
  • Cystic fibrosis
  • Dermatopolymyositis
  • Huntington’s disease
  • Hypoparathyroidism
  • Ischaemic heart disease (including angina pectoris)
  • Major depression
  • Multiple sclerosis
  • Myasthenia gravis
  • Narcolepsy
  • Obsessive compulsive disorder
  • Organ transplantation (immunosuppression)
  • Paget’s disease
  • Pituitary microadenomas
  • Psoriasis
  • Pemphigus
  • Stroke
  • Osteoporosis & Severe Osteopenia with risk factors
  • Psychoses