Last reviewed: November 2026. How we work: our editorial standards, corrections policy and how Curemed is paid. General information, not advice. A personalised recommendation follows a written needs analysis under the FAIS Act.
By Roxanne Hurter-Ehlers, Director of People and Governance at Curemed. Reviewed by Hagop Jaghlassian, CEO.
South African medical schemes must cover the 26 chronic conditions on the Chronic Disease List (CDL), counting type 1 and type 2 diabetes separately. Every benefit option, including hospital plans and entry-level options, must fund the diagnosis, medical management and medication for these conditions as Prescribed Minimum Benefits (PMBs). Payment in full applies when you use the scheme designated service provider (DSP) and the care falls within the published treatment algorithm for the condition.
In short
- The Chronic Disease List in South Africa is set in regulation, so no scheme and no option can leave a CDL condition out.
- Cover means diagnosis, medical management and medication up to the level of the published treatment algorithm, not every possible medicine or test.
- Using a provider outside the DSP by choice, or declining a suitable formulary medicine, can lead to a co-payment.
- Waiting periods can delay CDL cover for people who join after 90 days or more without medical scheme membership.
Which chronic conditions are on the Chronic Disease List?
The CDL forms part of Annexure A of the General Regulations under the Medical Schemes Act 131 of 1998. It was inserted by Government Notice R.1360 of 4 November 2002 and amended by Government Notice 1397 of 6 October 2003, which added ulcerative colitis and removed a duplicate entry.
The CDL conditions are set out below in alphabetical order, with a simple body system grouping added for easy reading.
| No. | CDL condition | Body system group |
|---|---|---|
| 1 | Addison disease | Endocrine |
| 2 | Asthma | Respiratory |
| 3 | Bipolar mood disorder | Mental health |
| 4 | Bronchiectasis | Respiratory |
| 5 | Cardiac failure | Cardiovascular |
| 6 | Cardiomyopathy | Cardiovascular |
| 7 | Chronic renal disease | Kidney |
| 8 | Chronic obstructive pulmonary disease | Respiratory |
| 9 | Coronary artery disease | Cardiovascular |
| 10 | Crohn disease | Digestive |
| 11 | Diabetes insipidus | Endocrine |
| 12 | Diabetes mellitus type 1 | Endocrine |
| 13 | Diabetes mellitus type 2 | Endocrine |
| 14 | Dysrhythmias | Cardiovascular |
| 15 | Epilepsy | Neurological |
| 16 | Glaucoma | Eye |
| 17 | Haemophilia | Blood |
| 18 | Hyperlipidaemia | Cardiovascular |
| 19 | Hypertension | Cardiovascular |
| 20 | Hypothyroidism | Endocrine |
| 21 | Multiple sclerosis | Neurological |
| 22 | Parkinson disease | Neurological |
| 23 | Rheumatoid arthritis | Autoimmune and joint |
| 24 | Schizophrenia | Mental health |
| 25 | Systemic lupus erythematosus | Autoimmune and joint |
| 26 | Ulcerative colitis | Digestive |
Why do some sources say 25 or 27 CDL conditions?
The regulation prints type 1 and type 2 diabetes on one line. Counted as one entry the list has 25 conditions, which is how the Council for Medical Schemes (CMS) describes it. Counted separately, the total is 26.
Some scheme brochures show 27 because they add HIV. HIV is not on the regulatory CDL, but HIV infection, including antiretroviral therapy, is covered as a PMB diagnosis and treatment pair. The number in a brochure can therefore differ from the regulation without the legal cover being any different.
How does the CDL fit into Prescribed Minimum Benefits?
According to the CMS explanation of Prescribed Minimum Benefits, PMBs have three parts: any emergency medical condition, about 270 diagnosis and treatment pairs, and the chronic conditions on the CDL. Regulation 8(1) requires every benefit option to pay the diagnosis, treatment and care costs of PMB conditions in full, without co-payment or deductibles.
That duty applies to every option a scheme offers. A lower contribution does not remove a CDL condition from cover, although the DSP and the formulary can differ from one option to the next.
What does cover for a CDL condition mean in practice?
Annexure A describes the treatment as diagnosis, medical management and medication, to the extent provided for by a therapeutic algorithm published by the Minister in the Government Gazette. The algorithms were published as Government Notice 1402 of 6 October 2003. In plain terms, the scheme must fund the baseline care in the algorithm, not every medicine or test a doctor could prescribe.
Scheme rules can then shape how you access that care. The table below summarises the rules a member can rely on.
| Rule | What it means for you | Source |
|---|---|---|
| Payment in full | Every option must pay PMB diagnosis, treatment and care costs in full, without co-payment or deductibles. | Regulation 8(1) |
| Designated service providers | The scheme may limit payment in full to its DSP and charge a co-payment if you choose another provider. No co-payment applies if the DSP could not provide the service or would delay it unreasonably, if you needed immediate treatment, or if no DSP was within reasonable proximity. | Regulation 8(2) and 8(3) |
| Formulary medicine | If you knowingly decline a clinically appropriate formulary medicine, the scheme may charge a co-payment. | Regulation 8(5) |
| Substitution | If a formulary medicine has been ineffective, or causes or would cause an adverse reaction, the formulary must allow an appropriate substitute without penalty to you. | Regulation 15I(c) |
| Savings account | Money in the member medical savings account may not be used to pay PMB costs. | Regulation 10(6) |
| Waiting periods | Whether PMBs are protected during a waiting period depends on your previous cover. | Section 29A of the Act |
What does this look like for one household?
Take a member with type 2 diabetes whose condition is registered with the scheme. If the script is filled at the DSP pharmacy with medicine on the formulary, the scheme pays in full. If the same member chooses a pharmacy outside the network, the scheme rules may add a co-payment to every script.
If the formulary medicine does not control the condition or causes side effects, the treating doctor can motivate for an alternative. The CMS consumer guidance says the scheme must then fund the alternative once the doctor provides proof. Regulation 15H(c) applies the same principle to treatment protocols.
What about chronic conditions that are not on the list?
A condition outside the CDL is not automatically excluded. It may fall under one of the diagnosis and treatment pairs, or the option you choose may cover it as an extra scheme benefit.
Richer options often publish extended chronic lists. Momentum, for example, lists 6 additional conditions on its Incentive option (32 in total) and 36 additional conditions on Extender and Summit (62 in total), subject to limits. Discovery has an Additional Disease List on its Executive and Classic Comprehensive plans.
These extras are scheme benefits, not legal minimums, and limits apply. The figures are as published by the schemes, so check the 2027 brochure for your option. A side by side medical aid comparison helps you see how options differ on this point.
Can a waiting period delay cover for a CDL condition?
Yes, in some cases. Section 29A of the Act sets out what a scheme may impose:
- No scheme membership for 90 days or more before applying: a general waiting period of up to 3 months and a condition-specific waiting period of up to 12 months, and PMBs may be excluded during these periods.
- Up to 24 months of prior cover that ended less than 90 days before applying: a condition-specific waiting period of up to 12 months, but not for treatment or diagnostic procedures covered within the PMBs.
- More than 24 months of prior cover: only a general waiting period of up to 3 months, with PMBs again protected.
- Changing options within the same scheme: no new waiting periods.
Consider two people with hypertension. One joins after four months without cover and can face a 12 month condition-specific waiting period during which the scheme does not fund the hypertension treatment. The other moves straight from a scheme where they had more than 24 months of cover, and the PMB treatment stays protected.
This is why a break in membership matters if you have a chronic condition. Our guide on when you can change your medical aid plan explains the timing rules for moving between options.
How do you register a chronic condition with your scheme?
CDL cover does not start by itself. The member or treating doctor applies for each chronic condition, and the scheme approves the application against its entry criteria. Discovery, for example, requires an application for each condition and lets the doctor submit it electronically, while Momentum asks members to have the treating doctor call the scheme.
Once approved, medicine must usually come from the DSP or network pharmacy to avoid a co-payment.
What can you do if your scheme refuses to pay?
Start with the scheme internal dispute process. If that fails, section 47 of the Act allows you to complain to the CMS through the CMS complaints procedure, by email at [email protected] or by phone on 0861 123 267. The scheme is given 30 days to respond to the CMS.
A decision of the Registrar can be appealed to the Council Appeals Committee under section 48 within 3 months, at no cost. A further appeal lies to the Appeal Board under section 50 within 60 days, for a prescribed fee.
A recent ruling shows the process at work. On 29 October 2026 the CMS Appeals Committee ordered KeyHealth to fund ravulizumab in full as a PMB for a beneficiary with paroxysmal nocturnal haemoglobinuria, without requiring an option upgrade, co-payments, deductibles or use of the medical savings account. This was a diagnosis and treatment pair case, not a CDL condition, the ruling said it is case specific, and Moonstone reported on 5 November 2026 that KeyHealth intends to appeal.
What should you check before the 2027 option deadlines?
Many schemes have set their 2027 option change deadlines between 30 November and 31 December 2026, and a few fall earlier, so confirm the date for your scheme. Before you confirm an option, check the following for each chronic condition in your household:
- Is the condition on the CDL, or does it depend on an extended list that only some options carry?
- Which pharmacy and doctors are the DSP on the option you are considering?
- Is your current medicine on the formulary for that option?
- Does the chronic registration carry over, or must your doctor reapply?
- If you are moving to a different scheme, which waiting periods could apply?
Our guide on how to choose a medical aid in South Africa covers the wider decision, and the list of medical aid schemes in South Africa is a starting point if you are looking beyond your current scheme.
How can a Curemed Advisor help?
A Curemed Advisor can compare how 2027 options treat the chronic conditions in your household, including the DSP, the formulary and any extended list, before the option deadline. You can contact Curemed to ask for that comparison.
A CDL benefit only works once the chronic application is approved and the scheme applies the rules correctly. CureClub, an exclusive member benefit from Curemed, is a dedicated healthcare support team that deals with the scheme on your behalf: chronic medication applications, authorisations, claim submissions and tracking, and escalation when the scheme gets something wrong. It is open to anyone on a registered South African medical scheme, although no outcome can be promised where a decision is correct under the scheme rules. Read more about CureClub healthcare support for medical scheme members.
Frequently asked questions
Does a hospital plan cover chronic medication for CDL conditions?
Yes. Regulation 8(1) applies to every benefit option, so a hospital plan must fund the diagnosis, medical management and medication for a CDL condition even if it has few or no day to day benefits. Expect the scheme to require registration of the condition and use of its DSP and formulary.
Can the scheme pay for CDL treatment from the medical savings account?
No. Regulation 10(6) states that money in a member medical savings account may not be used to pay for the costs of a PMB. If approved CDL claims are being deducted from savings, query it with the scheme.
Is HIV treatment a Prescribed Minimum Benefit?
Yes. HIV does not appear on the regulatory CDL, but HIV infection, including antiretroviral therapy, is a PMB diagnosis and treatment pair. Some schemes simply add it to their published chronic list, which is why that list may show 27 conditions.
What if there is no network pharmacy where you are staying?
Regulation 8(3) treats a service as involuntarily obtained when it was not available from the DSP, would have been unreasonably delayed, was needed immediately, or when no DSP was within reasonable proximity. In those cases no co-payment may be charged for using another provider. Contact the scheme before you travel so the arrangement is on record.
Can a scheme stop covering a chronic condition at year end?
Not a CDL condition. The list is set in regulation, so a scheme cannot remove one of those conditions from any option. Cover for conditions on an extended list is a scheme benefit under the scheme rules, which can change each year, so read the 2027 brochure for your option.
Roxanne Hurter-Ehlers
Director of People and Governance | Curemed Health and Wealth Consultants
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