AHREFS

If you are a Discovery Health member and registered on the Chronic Illness Benefit for Type 1 Diabetes, below is correspondence that you would have received via email.

Your cover for continuous glucose monitoring sensors

At Discovery Health Medical Scheme, we enhance our benefits so you have access to the best healthcare and devices you need to manage your health.

We’re excited to announce that we have enhanced the cover for continuous glucose monitoring (CGM) sensors. 

The level of cover you get for a CGM sensor depends on your chosen health plan and is subject to limits. CGM is increasingly becoming accepted as important technology to better manage diabetes, with strong evidence suggesting improved glucose control and lower risk of hypoglycaemia.

Continuous glucose monitoring benefit enhancements for 2022 

As a qualifying Scheme member, you have access to cover without any additional benefit authorisation. The prescription must come from your specialist physician, endocrinologist, paediatrician or healthcare provider on the Premier Plus Network. You can find a healthcare provider on our network by visiting www.discovery.co.za> Medical aid > Find a healthcare provider.

How you are covered for continuous glucose monitoring (CGM) 

Benefits are available for children and adults on all plan types, except the KeyCare plan, registered on the Chronic Illness Benefit (CIB) for type 1 diabetes. CGM sensors will be funded from your Scheme benefits up to a monthly limit depending on the age of the patient and your chosen health plan.

Children up to age 18:Adults:
  • Funded up to 100% of the monthly limit of R1,560 for all plan types except KeyCare
  • Comprehensive and Executive plan types: funded up to 100% of the monthly limit to a maximum of R1,560
  • For adults on all other plan types (excluding KeyCare plans): funded up to 50% of the monthly limit to a maximum of R780 for Priority, Saver, Core and Smart plan types

We will pay additional payments (co-payments) from your available day-to-day benefits to the maximum of the external medical item limit, where applicable. Your day-to-day benefits include your Medical Savings Account (MSA) or your Above Threshold Benefit (ATB). Members who have chosen a health plan without day-to-day benefits will have to pay the co-payments themselves.

Download the benefit guide to read more about your cover for diabetes and the Diabetes Care Programme.

 

Continuous glucose monitoring sensors covered under this benefit

The Dexcom G6 sensor is one of the sensors that is covered as part of this CGM benefit.

  • Where CGM sensors are funded from Scheme benefits, required glucometer strips and lancets will fund from the Chronic Illness Benefit (CIB) and will accumulate to the CGM monthly limit. Any amount above the monthly limit will be paid from available day-to-day benefits, where applicable.
  • CGM transmitters and readers will continue to fund from available day-to-day benefits for all plans where the External Medical Items (EMI) benefit applies.

You can buy your CGM sensor from participating pharmacies.