Medication

A lot of research and development goes into the development of new medicine, which is very expensive. Once the medicines are approved and placed on the market, the company who developed it receives exclusive rights, called a patent, for a period of 10 to 20 years in which other pharmaceutical companies cannot manufacture the same medication. This medication is known as brand-name/original medication. Once the patent period has expired, any pharmaceutical company can manufacture the same medication, as it is relatively simple to analyse the product chemically. These companies can manufacture the same medication at a much lower cost, as they do not need to pay for the research and development costs (already done with the brand-name/original product). This medication is known as generic medication. Therefore, generic medicines have the same active ingredients as the brand-name/original product and is identical in dosage, strength, quality and performance.

SELF-MEDICATION/OVER-THE-COUNTER (OTC) MEDICATION

Self-medication is schedule 1 and 2 medicine that does not require a prescription, but is dispensed by a pharmacist over the counter.

This benefit is only available on the Imperial Motus Med Health Plan and is paid at 100% of Mediscor Reference Price, up to a maximum of R210 per event and R1 190 per family per annum, subject to the acute medication limit below.


Acute Medicine

Is prescribed medication for a temporary condition or illness or prescribed medication to relieve the symptoms of infections, sprains, etc. and include injection material and flu vaccines.

Approved acute medication is paid at 100% of the Mediscor Reference Price List from the individual annual limit. Members should request healthcare providers to prescribe the less expensive generic equivalent of a medication, where available.

The Mediscor Reference Pricing (MRP) model is applicable to all medicines with generic equivalents. The MRP sets a maximum reimbursable price for a list of similar generic products with a lower cost than that of the original medicine. If a member chooses to use medicine that is more expensive than the MRP, the member will have to pay the difference between the price of the chosen medicine and the MRP. This is applicable to both preferred and non-preferred formulary medicines. Co-payments can be avoided or reduced by using a generic equivalent that costs less than the MRP. We encourage the use of generic equivalent medicines in the interest of cost-effective care.

Imperial Motus Med Health Plan

Acute medicines and injection material, including flu vaccines

Member family limit per annum, calculated as follows:
      R6 480 per member
      R4 070 per adult dependant
      R1 230 per child dependant (maximum of three children)

Imperial Motus Med Budget Plan

Acute medicines and injection material, including flu vaccines

Member family limit per annum, calculated as follows:
      R2 160 per member
      R1 370 per adult dependant
      R420 per child dependant (maximum of three children)


Chronic Medicine

A chronic condition is a medical condition that is persistent or otherwise long-lasting in its effects and requires ongoing, regular medication to manage the condition. The term chronic is often applied when the course of the medical condition lasts for more than three months.

The Scheme provides unlimited benefits for the treatment of 26 medical conditions that appear on the prescribed minimum benefit (PMB) chronic disease list (CDL). In addition to the PMB CDL, members will also receive benefits for the listed non-PMB chronic conditions.

Click here to view the chronic reference price formulary.

Imperial Motus Med Health Plan

Prescribed for PMB conditions and/or additional chronic conditions. Subject to the chronic medicine formulary only. A 25% co-payment applies when using non-formulary medicine.

Member family limit per annum, calculated as follows:
      Subject to pre-authorisation
      R22 000 per beneficiary

Imperial Motus Med Budget Plan

Prescribed for PMB conditions only. Subject to the chronic medicine formulary only. A 25% co-payment applies when using non-formulary medicine.

Member family limit per annum, calculated as follows:
      Subject to pre-authorisation
      PMBs only

 


PRESCRIBED MINIMUM BENEFIT AND NON-PRESCRIBED MINIMUM BENEFIT DISEASE LIST

  • CDL PMB conditions

    This is a list of the 26 PMB conditions covered by the Scheme in terms of legislation governing all medical schemes, and should be covered by each benefit plan offered by a medical scheme:

    • Addison disease
    • Asthma
    • Bipolar Mood Disorder
    • Bronchiectasis
    • Congestive Cardiac Failure (CCF)
    • Cardiomyopathy
    • Chronic Renal Failure
    • Coronary Artery Disease (CAD)
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Crohn disease
    • Diabetes Insipidus
    • Diabetes Mellitus type 1 & 2
    • Dysrhythmias
    • Epilepsy
    • Glaucoma
    • Haemophilia
    • Hyperlipidaemia
    • Hypertension
    • Hypothyroidism
    • Multiple Sclerosis (MS)
    • Parkinson disease
    • Rheumatoid Arthritis (RA)
    • Schizophrenia
    • Systemic Lupus Erythematosus (SLE)
    • Ulcerative Colitis
  • Non-CDL PMB conditions
    • Aplastic Anaemia
    • Benign Prostatic Hyperplasia
    • Cardiac Arrhythmia
    • Cushing disease
    • Endometriosis
    • Glomerular disease
    • Hyperthyroidism
    • Hypoparathyroidism
    • Menopause (HRT)
    • Pancarditis
    • Paraplegia
    • Pemphigus
    • Pituitary Adenoma
    • Polycystic Ovarian Syndrome
    • Pulmonary Hypertension
    • Pulmonary Interstitial Fibrosis
    • Quadriplegia
    • Sarcoidosis
    • Stroke (Cerebrovascular Accident)
    • Thromboangiitis Obliterans (TAO)
    • Thrombocytopenic Purpura (ITP)
    • Tuberculosis
    • Valvular Heart Disease
    • Venous Thromboembolism
  • Other chronic conditions
    • In addition to all the diseases on the PMB list, Health Plan Option members will also be covered for the following conditions:
    • Acne (severe)
    • ADHD
    • Allergic Rhinitis
    • Alzheimer disease
    • Ankylosing Spondylitis
    • Cystic Fibrosis
    • Depression
    • Dermatomyositis
    • Eating disorders
    • Eczema (severe)
    • Embolism and Thrombosis
    • Motor Neuron Disease
    • Myasthenia Gravis
    • Narcolepsy
    • Obsessive Compulsive Disorder
    • Osteoporosis
    • Paget disease
    • Psoriasis
    • Reflux disease
    • Scleroderma
    • Sjogren syndrome
    • Systemic Sclerosis
    • The following conditions are covered on the chronic list, but no condition registrations (basket) are loaded, only line authorisations
    • Cryoglobulnaemia
    • Dystonia
    • Huntington disease
    • Tic disorders
    • Organ Transplant