The Prescribed Minimum Benefits (PMBs)
Covered by Profmed medical aid scheme 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 list of 270 PMB medical conditions (defined in the Diagnosis Treatment Pairs – DTPs); and
- 26 chronic conditions defined in the Chronic Disease List (CDL).
Chronic Disease List (CDL)
From 1 January 2004 medical aid schemes were obliged to fund the cost of the diagnosis, medical management (consultations and procedures) and medication of a specified list of 26 chronic conditions.
This list is referred to as the prescribed minimum benefits “Chronic Disease List” (CDL).
These conditions are covered in full in terms of the Scheme rules if services are rendered according to the Scheme’s benefits, treatment plans and protocols, CDL medication lists, and claimed with the correct diagnostic (ICD-10) codes.
These conditions are covered on all Profmed’s options, but benefits will be more or less restrictive depending on the option the member has chosen.
|Bipolar Mood Disorder||Haemophilia|
|Chronic Obstructive Pulmonary Disorder||Hypothyroidism|
|Chronic Renal Disease||Multiple Sclerosis|
|Coronary Artery Disease||Parkinson’s Disease|
|Chrohn’s Disease||Rheumatoid Arthritis|
|Diabetes Mellitus Types 1 & 2||Systemic Lupus Erythematosus|