TFG Health Plus
Medicine cover for Chronic Disease List conditions
The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Scheme Rate. Medicines not on the medicine list will be funded up to the monthly Chronic Drug Amount (CDA).
Medicine cover for Additional Disease List conditions
You have further cover for Additional Disease List (ADL) conditions. There is no medicine list (formulary) for the ADL conditions. Approved medicine for these conditions will be funded up to the monthly CDA.
Treatment baskets for your approved Chronic Disease List conditions
The Chronic Illness Benefit will also cover a limited number of selected tests, procedures and specialist consultations each year for the ongoing management of your condition(s). You also have cover for four (4) GP consultations related to your approved PMB CDL condition(s) per year.
How to access the Chronic Illness Benefit
If you want to access cover from the Chronic Illness Benefit, you must apply for it. You must complete a Chronic Illness Benefit application form with your doctor and submit it for review. If your doctor uses HealthID, your doctor can apply for cover online, provided you have given your consent.
You need to meet the benefit entry criteria for your condition(s) to be registered on the Chronic Illness Benefit. You or your doctor may need to provide certain test results or extra information as indicated on the CIB application form for the condition(s) you are applying for. Please ensure that these documents are submitted with your application to avoid any delays in the process.
Documents for your Chronic Illness Benefit (CIB) cover:
Chronic Illness Benefit application form
TFG Health
Medicine cover for Chronic Disease List conditions
The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Scheme Rate. Approved medicine that is not on the medicine list will be funded up to the Reference Price for the medicines specific medicine category.
Treatment baskets for your approved Chronic Disease List conditions
The Chronic Illness Benefit will also cover a limited number of selected tests, procedures and specialist consultations each year for the ongoing management of your condition(s). You also have cover for four (4) GP consultations related to your approved PMB CDL condition(s) per year. You must nominate a GP in the GP network for your plan, to be your primary care doctor to manage your chronic conditions.
For members on the TFG Health option, nominate a primary care provider to manage your chronic condition(s)
For members on the TFG Health option, if you are approved for a Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) condition, you must nominate a general practitioner (GP) in the GP network for your plan, to be your primary care doctor for the management of your chronic conditions.
You can nominate your primary care doctor in three simple steps:
- Log in to the website
- Navigate to nominate your primary care doctor
- Follow the prompts in the Care Portal and select your primary care doctor and their associated practice.
You can access your Care Portal on the website to update your nominated GP should you need to do so.
How to access the Chronic Illness Benefit
If you want to access cover from the Chronic Illness Benefit, you must apply for it. You must complete a Chronic Illness Benefit application form with your doctor and submit it for review. If your doctor uses HealthID, your doctor can apply for cover online, provided you have given your consent.
You need to meet the benefit entry criteria for your condition(s) to be registered on the Chronic Illness Benefit. You or your doctor may need to provide certain test results or extra information as indicated on the CIB application form for the condition(s) you are applying for. Please ensure that these documents are submitted with your application to avoid any delays in the process.
Documents for your Chronic Illness Benefit (CIB) cover:
Chronic Illness Benefit application form