Diabetes Access Hub
Not sure whether your medical aid already covers sensor technology? Find out below!
Access to diabetes care in South Africa depends on several factors, including your age, plan type, type of diabetes, and whether you rely on public or private healthcare. We created this platform to help our diabetes community navigate these complexities and understand their access to care. We are launching with continuous glucose monitoring (CGM) benefits and hope to expand to cover all areas of diabetes healthcare over time.
Search for your medical scheme or administrator, or use the filters to find continuous glucose monitoring (CGM) access information relevant to you. Benefits, limits and application requirements differ between schemes and plans.
CGM benefit
- Children up to the age of 18 are funded in full on all plans except KeyCare plans.
- Adults on Executive and Comprehensive plans are funded in full.
- Adults over 18 on all other plans have a 50% co-payment for two sensors.
- All KeyCare plans are excluded from the CGM benefit.
How to access the benefit
- Register on the Chronic Illness Benefit (CIB). Call 0860 99 88 77 for members or 0860 44 55 66 for health partners. Type 1 ICD-10 code: E10.
- Get a FreeStyle Libre 2 prescription from a CGM network doctor. Find a network doctor in the Discovery app under “Find a healthcare provider”.
- Claim FreeStyle Libre 2 sensors from Pharmacy Direct, M-Kem or Medipost.
CGM benefit
- Type 1 diabetics aged below 19 years.
- R28,324 per beneficiary per year for consumables on Tanzanite One, Beryl, Ruby, Emerald, Emerald Value and Onyx.
- Members older than 19 may be considered on an ex gratia basis.
How to access the benefit
- Register on the Chronic Medicine Management Programme and PMB Care Plan by calling 0860 004 367.
- Get a FreeStyle Libre 2 prescription from a healthcare provider and submit the prescription and required documents to GEMS.
- Obtain FreeStyle Libre 2 from a designated service provider.
Ex gratia applications
Complete the GEMS ex gratia form and submit it with a statement of total family income and expenditure and supporting documents. Email exgratia@gems.gov.za, fax 0861 00 4367, deliver it to a regional office or post it to GEMS, Private Bag X782, Cape Town, 8000.
CGM benefit
- Type 1 diabetics aged below 19 years.
- Consumables are limited to R89,429 per family per year on Standard, Standard Select, BonComplete and BonClassic.
How to access the benefit
- Register on the Diabetes Care Programme by calling 0860 002 108 or emailing diabeticcare@bonitas.co.za.
- Get a FreeStyle Libre 2 prescription from a healthcare provider and submit the required documentation for pre-authorisation.
- Obtain medicine from a Bonitas Network Pharmacy or Pharmacy Direct. A 30% co-payment applies at a non-network pharmacy.
CGM benefit
- Children under 18 with Type 1 diabetes have access to insulin pumps and CGM devices without clinical criteria being applied.
- CGM device benefit of R30,855 per beneficiary per year.
- Available on the Marine and Aquarium plans.
How to access the benefit
- Register on POLMED’s Disease Risk Management Programme.
- Register on the Chronic Medicine Management Programme.
- Claim FreeStyle Libre 2 sensors from Pharmacy Direct, M-Kem or Medipost.
Send claims and related queries to polmedcurrentclaims@medscheme.co.za.
CGM benefit
There is no standard CGM benefit. Patients must submit a motivation.
How to access the benefit
- Register on the Diabetes Management Programme by calling 0860 117 859.
- Contact Medipost on 012 426 4000 and email the prescription to mhealth@medipost.co.za.
- Provide a renewed prescription to Medipost every six months.
Motivation information
Include relevant hypo- or hyperglycaemia, diabetic ketoacidosis (DKA), treatment and risk factors. These may include an inability to do finger-stick testing, medication, employment requirements and diabetes-related complications.
CGM benefit
- Available to members with Type 1 or Type 2 insulin-dependent diabetes.
- Members with Type 2 diabetes must use both basal insulin (ATC class A10AE) and bolus insulin (ATC class A10A).
- For children up to 18 and adults, sensors are funded up to 100% of the Scheme Rate.
How to access the benefit
Register on the Chronic Illness Benefit. For Essential and Basic plans, ask the treating healthcare professional to complete the registration form and email it to chronicbasicessential@bankmed.co.za. Core Saver, Traditional, Comprehensive and Plus plan applications should be emailed to chronic@bankmed.co.za. Healthcare professionals or pharmacists can call 0800 13 23 45.
CGM benefit
- Sensors are paid from the Major Medical Benefit and limited to R1,890 per beneficiary per month from a designated service provider pharmacy.
- On LA KeyPlus, sensors are jointly limited to the home-monitoring-device limit of R4,700 per person per year.
How to access the benefit
Register on the Chronic Illness Benefit and Diabetes Cardiometabolic Care Programme. Email Members_DCP@lahealthms.co.za with “register me” in the subject line and include the member’s name, surname and membership number, or call 0860 444 439.
CGM benefit
- Limited funding, subject to pre-authorisation.
- Pace 4: limited to R27,746 per family per year.
- Pace 3: limited to R23,218 per family per year.
- Pace 2: paid from savings first, then limited to R12,640 per family.
How to access the benefit
Register on the Bestmed Wellness Programme. Call 086 000 2378, email service@bestmed.co.za or use Bestmed’s WhatsApp chat line.
CGM benefit
Covered on MediPlus and MediElite.
How to access the benefit
Register on the health-management programme to access relevant benefits.
Source note: The process information supplied in the spreadsheet names Momentum Medical Scheme rather than Medihelp. Please confirm the correct registration process before publishing.
CGM benefit
There is no standard CGM benefit. Patients must submit a motivation.
How to access the benefit
Register on the Chronic Medicine Programme and Diabetes Care Programme. Call 086 000 2120 (or +27 10 597 4701), email Diabetesdiseasemanagement@medshield.co.za for the diabetes programme and medshieldauths@mediscor.co.za for the Chronic Medicine Programme.
Motivation information
Include relevant hypo- or hyperglycaemia, DKA, treatment and risk factors, including an inability to do finger-stick testing, medication, employment requirements and diabetes-related complications.
CGM benefit
- CGM benefit for children under 18 with Type 1 diabetes.
- Adults with Type 1 diabetes and people with Type 2 diabetes must submit a motivation.
How to access the benefit
Register on the Diabetes Care Programme by calling 0860 002 153 or emailing diabetescare@fedhealth.co.za. Send motivations to cmm@fedhealth.co.za and copy fedhealthcmm@medscheme.co.za.
Motivation information
Include relevant hypo- or hyperglycaemia, DKA, treatment and risk factors, including an inability to do finger-stick testing, medication, employment requirements and diabetes-related complications.
CGM benefit
There is no standard CGM benefit. Patients must submit a motivation.
How to access the benefit
Register on the Disease Risk Management Programme by calling 0860 101 176 or emailing authorisations@sizwehosmed.co.za.
Motivation information
Include relevant hypo- or hyperglycaemia, DKA, treatment and risk factors, including an inability to do finger-stick testing, medication, employment requirements and diabetes-related complications.
CGM benefit
There is no standard CGM benefit. Patients must submit a motivation.
How to access the benefit
Register on the Chronic Medicine Programme. Email the motivation to zzgplatinumhealthchronicmedication@platinumhealth.co.za and copy phclientliaison@platinumhealth.co.za.
Motivation information
Include relevant hypo- or hyperglycaemia, DKA, treatment and risk factors, including an inability to do finger-stick testing, medication, employment requirements and diabetes-related complications.
CGM benefit
- 100% of the lower of cost or the Scheme tariff.
- Continued patient compliance is required and monitored through the relevant managed healthcare programme.
How to access the benefit
Register for the Chronic Illness Benefit by emailing chronic.applications@sasolmed.co.za or calling 0860 002 134. Register for the Diabetes Care Programme using the same number or email enquiries@sasolmed.co.za. Access requires consultation with a Premier Plus GP and chronic approval for Type 1 or Type 2 diabetes.
CGM benefit
There is no standard CGM benefit. Patients must submit a motivation.
How to access the benefit
Register for the Disease Management Programme by calling 0861 083 084.
Motivation information
Include relevant hypo- or hyperglycaemia, DKA, treatment and risk factors, including an inability to do finger-stick testing, medication, employment requirements and diabetes-related complications.
CGM benefit
There is no standard CGM benefit. Patients must submit a motivation.
How to access the benefit
A doctor must register the patient’s chronic condition on the Chronic Medicine Management Programme by emailing samwumedcmm@medscheme.co.za or calling 0860 333 3387. Send motivations to the same email address.
Motivation information
Include relevant hypo- or hyperglycaemia, DKA, treatment and risk factors, including an inability to do finger-stick testing, medication, employment requirements and diabetes-related complications.
CGM benefit
There is no standard CGM benefit. Patients must submit a motivation.
How to access the benefit
Register on the Chronic Disease Management Programme by calling 0800 132 345. Send the motivation to chronic@medikredit.co.za.
Motivation information
Include relevant hypo- or hyperglycaemia, DKA, treatment and risk factors, including an inability to do finger-stick testing, medication, employment requirements and diabetes-related complications.
CGM benefit
There is no standard CGM benefit. Patients must submit a motivation.
How to access the benefit
Register on the Chronic Disease Management Programme by calling 0800 132 345. Send the motivation to chronic@medikredit.co.za.
Motivation information
Include relevant hypo- or hyperglycaemia, DKA, treatment and risk factors, including an inability to do finger-stick testing, medication, employment requirements and diabetes-related complications.
CGM benefit
There is no standard CGM benefit. Patients must submit a motivation.
How to access the benefit
Register on the Chronic Disease Management Programme by calling 0800 132 345. Send the motivation to chronic@medikredit.co.za.
Motivation information
Include relevant hypo- or hyperglycaemia, DKA, treatment and risk factors, including an inability to do finger-stick testing, medication, employment requirements and diabetes-related complications.
CGM benefit
Funding for FreeStyle Libre 2 is provided if the patient shares their data with CAMAF.
How to access the benefit
- Register on the Diabetes Management Programme by calling 0861 700 600 or emailing diabetes@camaf.co.za.
- Join CAMAF’s wellness programme and LifeSense.
- Share glucose data with the CAMAF clinic in LibreView using clinic code CAMAFDiabetes.
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Please note: Medical-scheme benefits and requirements can change. This directory is for general information only and does not guarantee cover. Confirm current benefits, plan rules and application requirements directly with your medical scheme.