The Acute Medication Benefit Explained

The Acute Medication benefit is designed to give you access to a wide range of medication prescribed by a network doctor. The formulary is extensive and favours generics where possible.

Over-the-Counter medication includes a formulary of schedule 0, 1 & 2 medication as well as flu shots. It is available without a prescription and excludes items like multi-vitamins, minerals and laxatives. There is a limit of R100 per event (claim) and annual limits of:

• R385 for Single Policies
• R825 for Family Policies

Please note that your doctor may prescribe medication that is not on the approved formulary which will not be covered. We do not interfere with the treatment plans of the medical providers.

You will need a prescription from a network doctor to access the unlimited medication benefit. OTC medication is available without a prescription but is limited.

There is a 1 month waiting period before any new member on a policy can claim under this benefit.

The benefit is "unlimited" which means that, in general, there is no limit as to how many times you may claim for medication (as long as it fits the prescription and the formulary).

You are only allowed to claim 3 times per year for prescriptions not issued by a network doctor.

The approved formulary of medication is very extensive and favours generic medication.

The full list of medication available is not generally published online by the product administrator because it is extensive and is regularly updated as medical protocols change. If you are unsure or need to know about a specific medication then you are welcome to speak to us and we will assist.

The benefit is unlimited but it is not uncapped. There are two cases where you may be required to make up a shortfall in a medication claim:

• Dispensing fees
• Co-payments

Dispensing fees are sometimes charged by a few pharmacists. We can't control this practice and do not cover dispensing fees. Fortunately, they are not usually expensive.

Co-payments may apply to specific medication. The benefit is unlimited, meaning it can be used as often as is necessary, but certain medication is capped in the amount that is covered. Other medication is fully covered.

If you are unsure or would like to know about a specific medication then you can always ask your network doctor for guidance or speak to us.