Dr.Herbst & Partners - Your family practitioners
Medical Aid

Firstly, some clarification regarding our relationship with the medical aid industry. Medical insurance is third-party insurance, similar to the insurance on your car/house/etc. We interact closely with your medical aid in an attempt to facilitate the claims process, however we are not employed or contracted by them.

In some instances we will act as designated service providers for a specific fund.

We currently act on behalf of the following funds:
  • Discovery
  • Bonitas
  • Onecare

We work closely with Discovery via their HealthID app. This allows us to manage a number of your benefits (pathology,chronic medication,etc) electronically. For some chronic conditions we may also be able to register and help you attain more Vitality benefits.

PMB Conditions – many patients are not aware that they qualify for chronic medication coverage when on a hospital plan.

The Chronic Disease List (CDL) specifies medication and treatment for the 25 chronic conditions that are covered in this section of the PMBs:

  • Addison's disease
  • Asthma
  • Bronchiectasis
  • Cardiac failure
  • Cardiomyopathy
  • Chronic obstructive pulmonary disorder
  • Chronic renal disease
  • Coronary artery disease
  • Crohn's disease
  • Diabetes insipidus
  • Diabetes mellitus types 1 & 2
  • Dysrhythmias
  • Epilepsy
  • Glaucoma
  • Haemophilia
  • Hyperlipidaemia
  • Hypertension
  • Hypothyroidism
  • Multiple sclerosis
  • Parkinson's disease
  • Rheumatoid arthritis
  • Schizophrenia
  • Systemic lupus erythematosus
  • Bipolar Mood Disorder

To manage risk and ensure appropriate standards of healthcare, so-called treatment algorithms were developed for the CDL conditions.

The algorithms, which have been published in the Government Gazette, can be regarded as benchmarks, or minimum standards, for treatment. This means that the treatment your medical scheme must provide for may not be inferior to the algorithms.

If you have one of the 25 listed chronic diseases, your medical scheme not only has to cover medication, but also doctors’ consultations and tests related to your condition. The scheme may make use of protocols, formularies (lists of specified medicines) and Designated Service Providers (DSPs) to manage this benefit.

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