What are prescribed minimum benefits?
Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected.
Is sleep apnea a PMB condition?
Sleep apnoea resulting in cor pulmonale is a Prescribed Minimum Benefit (PMB) condition under Diagnosis and Treatment Pair (DTP) code 910C. The DTP describes sleep apnoea as “Chronic upper airway obstruction, resulting in cor pulmonale.” The treatment component set forth is “Surgical and medical management.” 15.
Is depression a PMB condition?
The current PMBs 1. While Unipolar Depression is listed as one of the 272 DTP conditions (code 902T), and thus is in fact a PMB condition, there is still discrimination and a lack of guidance as to the treatment thereof.
What are chronic diseases examples?
The most common types of chronic disease are cancer, heart disease, stroke, diabetes, and arthritis.
Does gems cover frail care?
In a nutshell: frail care and medical aid Long-term frail care, either in a facility or through home-based nursing or assisted living, is not covered. Short-term stays in registered step-down, acute or sub-acute care facilities are covered, provided they are related to a major medical event.
What is Gems PMB?
Prescribed Minimum Benefits (PMBs) are the basic benefits that GEMS provides for certain medical conditions, such as asthma and hypertension as mandated by the Medical Schemes Act.
Is ADHD a PMB condition?
ADHD is not considered life threatening. It is consequently not a Prescribed Minimum Benefit (PMB) or Chronic Disease List (CDL) condition as outlined by the Medical Schemes Act.
What is above threshold benefit at Discovery?
The Above Threshold Benefit (ATB) gives you extra cover when your claims add up to a set amount called the Annual Threshold, if you are on an Executive, Comprehensive or Priority plan.
What is the difference between assisted living and frail care?
An Assisted Living Facility differs from a Nursing Home in that it places greater emphasis on personal privacy and autonomy than a Care Centre or Frail Care whereas a Care Centre is set up for people who need skilled medical professionals providing them care and services on a daily basis.
How much does frail care cost?
Frail care facilities can cost anywhere between R13 000 and R25 000 a month, depending on the facility and the quality of care.