What is a Medical Aid PMB List?
All medical aids must, by law, provide a minimum set of benefits. These apply no matter what benefit option they are on. This is the medical aid PMB list. The list ensures that people are able to gain access to a basic level of health care. And that’s no matter whether they have used up their benefits or not.
The PMB list does not cover all conditions. However, there is cover for two hundred and seventy medical conditions and twenty five chronic conditions. These include diabetes, for instance.
In addition, in terms of the medical aid PMB list, medical aids must cover the treatment of a medical emergency.
The approach as to whether or not the condition falls under the prescribed medical benefits. That depends entirely on diagnosis. In other words, a doctor will only consider the actual symptoms and not other factors. These include how the patient contracted the condition or how the injury occurred.
The doctor will make their diagnosis and from there the treatment regimen will be embarked on. Depending on the condition, the patient will either receive treatment in the hospital, at the doctor’s surgery or as an outpatient.
In cases of emergency medical care, dcotors must first stabilise the patient. From there the medical experts can take the issue of care and cover forward.
Medical Aid PMB List – Conditions Set
The medical aid must by law provide prescribed minimum benefits but it can put restrictions on how that cover works. For example, it can enforce a strict formulary, insist that patients use only network doctors and require that the member applies for this benefit.
The medical aid may, if it has the facility to do so, arrange for chronic medication to be provided on a set monthly basis. This would normally involve having to collect the medication at a pre-determined pharmacy or similar collection point.
Generally speaking, the medical aid must provide minimal care. So, it can opt to pay for generic medications only, for example. It may also limit the care in terms of the doctor that you may consult.
So, while they must provide cover, they do have a lot of latitude when it comes to determining what that cover will include and are able to set a range of restrictions on it.
The idea is to provide members with continuous care in the cases of certain medical illnesses so that members have the best chance of maintaining good health. The medical aids do not, however, have to pay for unproven or experimental treatments, or any original medications for which a generic option exists.
When it comes to determining whether or not you may receive prescribed medical benefits, the answer is fairly simple. If you are with a registered medical aid, you are entitled to receive such benefits.
Where you need to exercise care is when it comes to medical insurances. These are not governed by the same laws as medical aids and so you might not be able to enjoy the same level of cover.