What are the PMB conditions?
PMBs are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of: any emergency medical condition; a limited set of 271 medical conditions (defined in the Diagnosis Treatment Pairs); and.
Is COPD a PMB condition?
COPD is one of the PMBs and must be covered by medical aids. Medical cover for COPD includes diagnosis, treatment and care of the condition.
Is diabetes a PMB condition?
The basic principle remains: diabetes is a PMB condition and is not subject to the normal chronic benefit limits.
Is asthma a PMB condition?
Asthma is included in PMB regulations under both the di- agnostic treatment pairs (DTPs) and in the chronic disease list (CDL). The DTP includes 157D- Acute asthmatic attack; pneumonia due to respiratory syncytial virus in persons un- der age 3.
Is Spinal stenosis a PMB condition?
Spinal stenosis sometimes causes compression of the spinal cord, which is a prescribed minimum benefit (PMB) condition. Spinal stenosis can also cause compression of the nerve roots, the area where the nerves split out of the cord. Nerve root compression is not a PMB condition.
Is osteoarthritis a PMB condition?
Osteoarthritis is the most common joint disease. The condition is however not included in the PMB regulations.
Is lupus a PMB condition?
PMBs and chronic cover for lupus In South Africa, systemic lupus erythematosus is one of 27 chronic disease list conditions identified by the Medical Schemes Act as eligible for prescribed minimum benefits (PMBs).
Is osteoporosis a PMB condition?
Since osteoporosis does not feature on the so-called Prescribed Minimum Benefits (PMB) list, medical aid schemes either refuse to pay or draw up their own arbitrary funding criteria and financially cap the reimbursement of osteoporosis treatment. This does not happen with other chronic non-communicable diseases.
Is anemia a PMB condition?
Iron deficiency anemia is a PMB condition only if the condi- tion is life-threatening. Iron deficiency anaemia that is life- threatening is included in the PMBs under Diagnosis and Treatment Pair (DTP) code 236K.
Is arthritis a PMB condition?
Rheumatoid arthritis has been identified as a Chronic Disease List (CDL) condition and is eligible for state-imposed Prescribed Minimum Benefits (PMBs).
Is neuropathy a PMB condition?
Management of neuropathic pain Neuropathic pain should be covered as PMB when the underlying aetiology is a PMB condition. Most cases of neuropathy respond to management of the underlying disease process or removal of the aetiological agent.
What are the types of PMB conditions?
List of PMB conditions: Urinary and male genital system List of PMB conditions: Female reproductive system We empower South Africans to manage their health: find a doctor, compare medical aid plans side by side, see plan benefits, stay up to date with healthcare innovation, discuss health issues on our Forum. [email protected]
What are the 270 PMB conditions?
We also have the full list of all 270 PMB conditions. Remember, all life-threatening conditions are PMBs, and need to be covered by medical aid. Addison’s Disease. Asthma. Bipolar Mood Disorder. Bronchiectasis. Cardiac Failure. Cardiomyopathy. Chronic Renal Disease.
Can the legal interpretation of PMB conditions be used?
It may not be used as the legal interpretation of PMB conditions. In the event of conflict between this interpretation and the definition of conditions set out in Annexure A to the regulations, the definition of conditions contained in the regulations will prevail.
What happens if I exhaust my PMB Chronic Medicine limit?
Any chronic medication you claim for will then reduce that limit, regardless of whether or not it is one of the PMB chronic conditions. However, if you exhaust your chronic medicine limit, your scheme will have to continue paying for any chronic medication you obtain from its DSP for a PMB condition.