Guide To Prescribed Minimum Benefits

GUIDE TO PRESCRIBED
MINIMUM BENEFITS
DISCOVERY HEALTH MEDICAL SCHEME
2022
Discovery Health Medical Scheme, registration number 1125, is regulated by the Council for Medical Schemes and administered by Discovery Health (Pty) Ltd, registration
number 1997/013480/07, an authorised financial services provider.
Overview
All registered medical schemes in South Africa need to cover Prescribed Minimum Benefits (PMBs) on all the plans they offer t o
their members. In terms of the Medical Schemes Act No. 131 of 1998, Prescribed Minimum Benefits (PMBs) are a set of defined
benefits that all registered medical schemes in South Africa are obliged to provide for all their members. All members have access
to these benefits, irrespective of their chosen plan type. Prescribed Minimum Benefits (PMBs) ensure that all medical scheme
members have access to continuous care for a defined list of conditions to improve their health.
Discovery Health Medical Scheme plans are structured in a way that maximises cover no matter which health plan you choose.
Some plans cost more but offer more comprehensive benefits, while others have lower contributions with fewer benefits.
Regardless of this, all our health plans cover more than just the minimum benefits required by law. Always consult your Health
Plan Guide on www.discovery.co.za to see how you are covered.
This document tells you how we cover out-of-hospital Prescribed Minimum Benefits (PMBs). For more information on your in-
hospital Prescribed Minimum Benefit (PMB) cover please visit our website www.discovery.co.za under Medical Aid > Manage your
health plan > Find important documents and certificates.
About some of the terms we use in this document

There may be some terms we refer to in this document that you may not be familiar with. Here are the meanings of these terms.
TERMINOLOGY DESCRIPTION
Chronic Disease List (CDL) A defined list of chronic conditions we cover according to the Prescribed Minimum Benefits (PMBs).
Chronic Drug Amount (CDA) The Chronic Drug Amount (CDA) is the monthly amount that we pay up to for a medicine class,
subject to a member's plan type. This applies to chronic medicine that is not listed on the formulary
or medicine list. The Chronic Drug Amount (CDA) does not apply to the Smart and KeyCare plans, on
these plans the cost of the lowest formulary listed drug will apply.
Co-payment This is an amount that you need to pay towards a healthcare service. The amount can vary by the
type of covered healthcare service, place of service or if the amount the service provider charges is
higher than the rate we cover. If the co-payment amount is higher than the amount charged for the
healthcare service, you will have to pay for the cost of the healthcare service.
Day-to-day benefits These are the available funds allocated to the Medical Savings Account (MSA) and Above Threshold
Benefit (ATB). Depending on the plan you choose, you may have cover for a defined set of day-to-
day benefits. The level of day-to-day benefits depends on the plan you choose.
Designated service provider A healthcare provider (for example doctor, specialist, allied healthcare professional, pharmacist or
(DSP) hospital) who we have an agreement with to provide treatment or services at a contracted rate. Visit
www.discovery.co.za or click on Find a healthcare provider on the Discovery app to view the full list
of DSPs.
Diagnosis and treatment A diagnosis and treatment pair links a specific diagnosis to a treatment based on best practice
pair (DTP) healthcare and affordability of the treatment and broadly indicates how each of the 271 Prescribed
Minimum Benefit (PMB) conditions should be treated.
Discovery Health Rate This is a rate we pay for healthcare services from hospitals, pharmacies, healthcare professionals
(DHR) and other providers of relevant health services.
Discovery Health Rate for This is the rate we pay for medicine. It is the Single Exit Price of medicine plus the relevant
Medicine dispensing fee.
Emergency medical An emergency medical condition, also referred to as an emergency, is the sudden and at the time,
condition unexpected onset of a health condition that requires immediate medical and surgical treatment,
where failure to provide medical or surgical treatment would result in serious impairment to bodily
GUIDE TO PRESCRIBED MINIMUM BENEFITS
Discovery Health Medical Scheme, registration number 1125, is regulated by the Council for Medical Schemes and administered by Discovery Health (Pty) Ltd,
registration number 1997/013480/07, an authorised financial services provider. Find a healthcare provider, Discovery MedXpress, HealthID and the Discovery app are brought
to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised financial services provider and administrator of medical schemes. 2
TERMINOLOGY DESCRIPTION
functions or serious dysfunction of a bodily organ or part or would place the person’s life in serious
jeopardy.
An emergency does not necessarily require a hospital admission. We may ask you for additional
information to confirm the emergency.
Member The reference to member in this document also includes dependants, where applicable.
Reference Price The price at which non-formulary medicine that falls in the same medicine category and generic
group as the formulary medicine is paid by the Scheme.
Related accounts Any account other than the hospital account for in-hospital care. This could include the accounts for
the admitting doctor, anaesthetist and any approved healthcare expenses like radiology or
pathology.
What is a Prescribed Minimum Benefit (PMB)?
Prescribed Minimum Benefits (PMBs) are guided by a list of medical conditions as defined in the
Medical Schemes Act of 1998
According to the Medical Schemes Act 131 of 1998 and its Regulations, all medical schemes have to cover the costs related to the
diagnosis, treatment and care of:
Any life-threatening emergency medical condition

A defined set of 271 diagnostic treatment pairs
27 chronic conditions (Chronic Disease List (CDL) conditions).
Please refer to the Council for Medical Schemes website www.medicalschemes.co.za for a full list of the 271 diagnostic treatment
pairs. All medical schemes in South Africa have to include the Prescribed Minimum Benefits (PMBs) in the plans they offer to their
members.
Requirements you must meet to benefit from Prescribed Minimum Benefits (PMBs)
There are certain requirements before you can benefit from Prescribed Minimum Benefits (PMBs). The requirements are:
The condition must qualify for cover and be on the list of defined Prescribed Minimum Benefit (PMB) conditions.
The treatment needed must match the treatments in the defined benefits on the Prescribed Minimum Benefit (PMB) list.
You must use the Scheme's designated service providers (DSPs) for full cover unless there is no DSP applicable to your plan.
If you do not use a designated service provider (DSP) we will pay up to 80% of the Discovery Health Rate (DHR). You will be
responsible for the difference between what we pay and the actual cost of your treatment. This does not apply in emergencies.
However, even in these cases, where appropriate and according to Scheme Rules, you may be transferred to a hospital or other
service providers in our network once your condition has stabilised, to avoid co-payments. If your treatment doesn’t meet the
above criteria, we will pay according to your plan benefits.
Claims for services received outside of the borders of South Africa will be covered in accordance with your chosen plan benef its
and rules. For more information on cover while travelling, please refer to the guide on the Cover for treatment received abroad,
available on our website www.discovery.co.za under Medical Aid > Manage your health plan > Find important documents and
certificates.
The medical condition must be part of the list of defined conditions for Prescribed Minimum
Benefits (PMBs)
You should send the Scheme the results of your medical tests and investigations that confirm the diagnosis of the condition. This
will help us to identify that your condition qualifies for the treatment. Your treating doctor needs to complete an application form
and provide the relevant documentation to assist us in confirming the diagnosis.
The treatment needed must match the treatments included in the defined benefits
There are standard treatments, procedures, investigations and consultations for each Prescribed Minimum Benefit (PMB)
condition on the 271 diagnostic treatment (DT) Prescribed Minimum Benefit (PMB) list. These defined benefits are supported by
thoroughly researched, evidence based clinical protocols, medicine lists (formularies) and treatment guidelines.
Please refer to the Council for Medical Schemes website www.medicalschemes.co.za for a full list of the 271 diagnostic treatment
pairs.
An example of a Prescribed Minimum Benefit (PMB) provision
Below is an example of a Prescribed Minimum Benefit (PMB) condition and the treatment that qualifies for PMB cover:
PROVISION PROVISION DESCRIPTION TREATMENT ICD-10 CODE
236K Iron deficiency; vitamin and other nutritional Medical management D50.8-
deficiencies – life-threatening Other iron deficiency anaemias
• The Prescribed Minimum Benefit (PMB) Provision is 236K. This is one of the listed 271 Provisions (listed 271 conditions) as
published in the Medical Schemes Act and Regulations.
• In this example the Provision Description lists “Iron deficiency; vitamin and other nutritional deficiencies - life threatening”.
The provision states that the condition should be life threatening. For this provision, if the diagnosis is not a life-threatening
episode, the condition does not qualify for Prescribed Minimum Benefit (PMB) funding.
• The Treatment covered as a Prescribed Minimum Benefit (PMB) for this provision includes medical management for example
medicine, doctor consultations investigations etc.
• In addition to the above information, the Council for Medical Schemes (CMS) also provides ICD-10 codes (e.g., D50.8) that fall
within the 236K Provision, as per the last column in the above table. The ICD-10 codes (diagnosis codes) are an industry guide
as to which conditions may qualify for Prescribed Minimum Benefit (PMB) cover, subject to them still meeting the Provision
Description and treatment criteria.
For this example, in order to qualify for the out-of-hospital Prescribed Minimum Benefit (OHPMB) funding, you or your healthcare
professional may apply for medical management of life-threatening iron deficiency, vitamin and other nutritional deficiencies. This
criterion stated in the Provision description needs to be met to qualify for out-of-hospital Prescribed Minimum Benefit (OHPMB)
funding related to the treatment as outlined.
Any application for treatment that is not listed in the “treatment” provision for a condition, cannot be considered as Prescribed
Minimum Benefit (PMB) as it does not form part of the prescribed treatment that forms part of PMB level of care. Speak to your
healthcare professional to ensure that all criteria for treatment are met before applying for Prescribed Minimum Benefit (PMB)
cover.
How we pay claims for Prescribed Minimum Benefits (PMBs) and non-Prescribed
Minimum Benefits (non-PMB)
We pay for confirmed Prescribed Minimum Benefits (PMBs) in full if you receive treatment from a designated service provider
(DSP) and/or preferred supplier. Treatment received from a non-designated service provider (non-DSP) or medical items from a
supplier who is not a preferred supplier may be subject to a co-payment if the healthcare provider or supplier charges more than
the amount we pay.
We have preferred suppliers for external medical items such as CPAP machines or rental oxygen. Where a non-preferred supplier
is used you may have a co-payment. To view the External Medical Items Benefit guide visit www.discovery.co.za under Medical Aid
> Manage your health plan > Find important documents and certificates.
We pay for benefits not included in the Prescribed Minimum Benefits (PMBs) from your appropriate and available plan benefits,
according to the rules of your chosen health plan. Visit www.discovery.co.za or click on Find a healthcare provider using your
Discovery app or call us on 0860 99 88 77 to find a participating designated service provider (DSP).
There are some circumstances where you do not have cover for Prescribed
Minimum Benefits (PMBs)
This can happen when you join a medical scheme for the first time, with no previous medical scheme membership. Also, if you join
a medical scheme more than 90 days after leaving your previous medical scheme. In both these cases, the Scheme may impose a
waiting period, during which you and your dependants will not have access to the Prescribed Minimum Benefits (PMBs), regardle ss
of the conditions you may have. We will communicate with you at the time of applying for your membership if any waiting periods
apply to you or your dependants.
There are a few instances when the Scheme will only pay a claim as a Prescribed
Minimum Benefit (PMB)
This happens when you have a waiting period or when you have treatments linked to conditions that are excluded by your health
plan. This can be a three-month general waiting period or a 12-month condition-specific waiting period. Depending on the
category of waiting periods, you may still qualify for cover from the Prescribed Minimum Benefits (PMBs).
You and your dependants must register to get cover for Prescribed Minimum
Benefits (PMBs) and Chronic Disease List (CDL) conditions
How to register your chronic or Prescribed Minimum Benefit (PMB) conditions to get cover from
your risk benefits
There are different types of Prescribed Minimum Benefits (PMBs). These include Prescribed Minimum Benefit (PMB) cover for in-
hospital admissions, conditions covered under the Chronic Disease List (CDL), the out-of-hospital management of PMB conditions,
and treatment of PMB conditions such as HIV and oncology.
To apply for out-of-hospital Prescribed Minimum Benefits (OHPMBs) or cover for a Chronic Disease List (CDL) condition, you must
complete the Prescribed Minimum Benefit or a Chronic Illness Benefit application form.
• Up to date forms are always available on www.discovery.co.za under Medical Aid > Manage your health plan > Find
important documents and certificates.
• You can also call 0860 99 88 77 to request any of the above forms.
For more information on the Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions, HIV or Oncology and how
to register please refer to the relevant benefit guides available on www.discovery.co.za under Medical Aid > Manage your health
plan > Find important documents and certificates.
To confirm your in-hospital cover for Prescribed Minimum Benefit (PMB) conditions, you can call us on 0860 99 88 77 and request
an authorisation. We will then tell you about your cover.
Why it is important to register your Prescribed Minimum Benefit (PMB) or chronic condition
We pay for specific healthcare services related to each of your approved conditions. These services include approved treatment,
medicine, consultations, blood tests and other defined investigative tests. We pay for these services from your Prescribed
Minimum Benefits (PMBs) which will not affect your day-to-day benefits.
We will pay for treatment or medicines that fall outside the defined benefits and that are not approved, from your available day-to-
day benefits, according to your chosen health plan. If your health plan does not cover these expenses, you will have to pay these
claims.
Who must complete and sign the registration form when applying for Prescribed Minimum
Benefit (PMB) or chronic condition cover?
The person with the Prescribed Minimum Benefit (PMB) or chronic condition must complete the relevant application form with the
help of their treating doctor. The main member must complete and sign the form if the patient is a minor.
Each person with Prescribed Minimum Benefit (PMB) or chronic condition(s) must register their specific condition(s) separately.
You only have to register once for a chronic condition. If your medicine or other treatment changes, your doctor can let us know
about these changes.
For new conditions, you will have to register each new condition before we will cover the treatment and consultations from your
Prescribed Minimum Benefits (PMBs) and not from your day-to-day benefits.
Additional documents needed to support your application

You must send the Scheme the results of the medical tests and investigations that confirm the diagnosis of the condition for which
you are applying. This will help us to identify whether your condition qualifies as a Prescribed Minimum Benefit (PMB). Remember
to keep a copy of the completed form for your records.
Where to send the completed application form(s)
You must send the completed Prescribed Minimum Benefit (PMB) application form using either of the following methods:
Email to: PMB_APP_FORMS@discovery.co.za
Post to: Discovery Health, PMB Department, PO Box 652919, Benmore, 2010.
You must send the completed Chronic Illness Benefit (CIB) application form using either of the following methods:
Email to: CIB_APP_FORMS@discovery.co.za
Post to: Discovery Health, CIB Department, PO Box 652919, Benmore, 2010.
We will let you know if we approve your application for Prescribed Minimum Benefit (PMB) or
chronic condition cover and what you must do next
We will let you know about the outcome of your application and will send you a letter confirming your cover for the condition,
using your preferred method of communication. If your application meets the requirements for cover from Prescribed Minimum
Benefits (PMBs), we will automatically pay the associated approved blood tests and other defined investigative tests, treatment,
medicine and consultations for the diagnosis and treatment of your condition from your Prescribed Minimum Benefits (PMBs), an d
not from your day-to-day benefits.
The treatment needed must match the treatments in the published defined benefits on the Prescribed Minimum Benefit (PMB) list
as there are standard treatments, procedures, investigations and consultations for each condition on the PMB list. These defined
benefits are supported by thoroughly researched evidence, based on clinical protocols, medicine lists (formularies) and treat ment
guidelines.
What happens if you need treatment that falls outside of the defined benefits
If you need treatment that falls outside of the defined benefits you and your healthcare professional can send additional clinical
information with a detailed explanation of the treatment that is needed and we will review it. If this treatment is not approved as
Prescribed Minimum Benefit (PMB), it can be paid from your available day-to-day benefits, according to your chosen health plan. If
your health plan does not cover these expenses, you will have to pay the costs of these claims.
To appeal against the funding decision on Prescribed Minimum Benefit (PMB) cover or cover for chronic medicine or treatment:
Download the out-of-hospital Prescribed Minimum Benefit (OHPMB) Appeal form or Chronic Illness Benefit Appeal form. Up
to date forms are always available on www.discovery.co.za under Medical Aid > Manage your health plan > Find important
documents and certificates. You can also call 0860 99 88 77 to request any of the above forms.
Complete the form with the assistance of your doctor or healthcare professional.
Send the completed, signed form, along with any additional medical information, by email to
PMB_APP_FORMS@discovery.co.za or to CIB_APP_FORMS@discovery.co.za.
If we approve the requested medicine or treatment on appeal, we will automatically pay these from either the Prescribed
Minimum Benefit (PMB) or Chronic Illness Benefit (CIB), whichever is applicable. If the appeal is unsuccessful and you are not
satisfied with the outcome you may also lodge a formal dispute by following the Scheme’s disputes process on
www.discovery.co.za.
For more information on your cover for Chronic or Prescribed Minimum Benefit (PMB) medicine please visit our website
www.discovery.co.za under Medical Aid > Manage your health plan > Find important documents and certificates.
What happens if there is a change in your approved medicine
For chronic conditions, your treating doctor or dispensing pharmacist can make changes to your medicine telephonically by cal ling
0860 99 88 66 or by emailing it to CIB_APP_FORMS@discovery.co.za.
For other PMB conditions, the treating doctor or dispensing pharmacist can only make changes to medicine by sending the
updated prescription via email to PMB_APP_FORMS@discovery.co.za.
If you get your medicine or treatment from a provider of your choice instead of
the Scheme’s designated service providers (DSPs)
You must use doctors, specialists and other healthcare providers, including pharmacies, who we have a payment arrangement
with, to avoid a co-payment. This does not apply in the event of an emergency or where the use of a non-designated service
provider (non-DSP) is involuntary or when no DSP is available. If you use a healthcare provider who we do not have a payment
arrangement with, you will have to pay part of the treatment costs yourself.
In an emergency, you can go directly to hospital and notify the scheme as soon as possible of their admission. In the case of an
emergency, you are covered in full for the first 24 hours or until you are stable enough to be transferred.
Go to www.discovery.co.za or click on Find a healthcare provider using your Discovery app or call us on 0860 99 88 77 to find a
participating designated service provider (DSP).
Discovery MedXpress is a convenient medicine ordering service that provides seamless ordering of prescribed medicines via SMS,
the Discovery website and the mobile app. You can get your monthly chronic medicine delivered to your door or collect your
medicine in-store at a participating pharmacy at no extra cost to you. Learn more about the benefits of using MedXpress and how
to order your medicine.
Getting the most out of your cover
Elective admissions for Prescribed Minimum Benefit (PMB) conditions and procedures are covered in full if you choose to use a
designated service provider (DSP) hospital and designated service provider (DSP) treating doctors. Where your primary treating
doctor is a designated service provider (DSP), reimbursement will be made in full without any co-payment to yourself for any
required anaesthetic services you may need during your admission.
The below conditions need to be met for full cover for these providers:
• You are being admitted for a procedure for a Prescribed Minimum Benefit (PMB) condition
• Your chosen hospital or day facility is on the Prescribed Minimum Benefit (PMB) network for your plan
• Your primary treating doctor is on the Prescribed Minimum Benefit (PMB) network for your plan.
If all of the above conditions are met your hospital, doctor and anaesthetist accounts will be covered in full.
Nominate a GP as your primary care doctor
If you are registered for a chronic condition, you will be prompted to nominate a primary care network doctor according to your
chosen health plan. This nomination process will not impact your benefits and cover in 2022. We will share communication duri ng
the course of 2022 to explain:
▪ The process to follow to nominate your primary care doctor (GP)
▪ How to change your nominated GP, if necessary.
Visit www.discovery.co.za under Medical aid > Find a healthcare provider or click on Find a healthcare provider using your
Discovery app or call us on 0860 99 88 77 to find a participating designated service provider (DSP).
What to do if there is no available designated service provider (DSP) at the time of your request
There are some instances when you will still have full cover if you use a healthcare provider who we do not have a designated
service provider (DSP) arrangement with. An example of this is in an emergency, cases when the use of a non-designated service
provider (non-DSP) is involuntary or when there is no DSP available.
In cases where there are no services or beds available at a designated service provider (DSP) when you or one of your dependants
need treatment, you can contact us on 0860 99 88 77 and we will make arrangements for an appropriate facility or healthcare
provider to accommodate you.
Cover for Cancer

Depending on your chosen health plan, once you are registered on the Oncology Programme, the Scheme covers your approved
cancer treatment over a 12-month cycle up to the Discovery Health Rate (DHR), in accordance with your plan benefits.
Cancer treatment that is a Prescribed Minimum Benefit (PMB) is always covered in full. All Prescribed Minimum Benefit (PMB)
treatment costs add up to the oncology cover amount for your plan. If your treatment costs more than the cover amount, we will
continue to cover your Prescribed Minimum Benefit (PMB) cancer treatment in full.
For more information on your cover for cancer please visit our website www.discovery.co.za under Medical Aid > Manage your
health plan > Find important documents and certificates.
Cover for HIV
When your Premier Plus GP enrols you on the HIV Care Programme to manage your condition, you are covered for the care you
need, which includes additional cover for social workers. You can be assured of confidentiality at all times.
For more information on your cover for HIV please visit our website www.discovery.co.za under Medical Aid > Manage your health
plan > Find important documents and certificates.
Cover for COVID-19
The WHO Global Outbreak Benefit provides cover for global disease outbreaks recognised by the World Health Organization
(WHO) such as COVID-19. This benefit offers cover for the vaccine, out-of-hospital management and appropriate supportive
treatment related to the management of acute COVID-19 and long COVID. Please visit our website www.discovery.co.za under
Medical Aid > Benefits and cover > COVID-19 Benefits for more information.
Cover for Prescribed Minimum Benefit (PMB) admissions

You must preauthorise all hospital admissions. When you call us to preauthorise your admission, we will tell you how you are
covered. You must use designated services providers (DSPs) in our network. This does not apply in emergencies. Where
appropriate and according to the rules of the Scheme, you may be transferred to a hospital or other service providers in our
network once your condition has stabilised. If you do not use a designated service provider (DSP) we will pay up to 80% of the
Discovery Health Rate (DHR) for the admission.
In instances where a co-payment or deductible is applicable to the admission, additional information such as a scan or scope
report will be required. If the Prescribed Minimum Benefit (PMB) condition is confirmed no co-payments or deductibles will be
applicable.
For more information on your in-hospital Prescribed Minimum Benefit (PMB) cover please visit our website www.discovery.co.za
under Medical Aid > Manage your health plan > Find important documents and certificates.
Contact us
Tel (members): 0860 99 88 77, Tel (health partners): 0860 44 55 66

Go to www.discovery.co.za to Get Help or ask a question on WhatsApp. Save this number 0860 756 756 on your phone and say
"Hi" to start chatting with us 24/7.
PO Box 784262, Sandton, 2146. 1 Discovery Place, Sandton, 2196.
Complaints process
Discovery Health Medical Scheme is committed to providing you with the highest standard of service and your feedback is
important to us. The following channels are available for your complaints and we encourage you to follow the process:
1| STEP 1 – TO TAKE YOUR QUERY FURTHER:
If you have already contacted the Discovery Health Medical Scheme and feel that your query has still not been resolved, please
complete our online complaints form on www.discovery.co.za. We would also love to hear from you if we have exceeded your
expectations.
2| STEP 2 – TO CONTACT THE PRINCIPAL OFFICER:
If you are still not satisfied with the resolution of your complaint after following the process in Step 1 you are able to escalate your
complaint to the Principal Officer of the Discovery Health Medical Scheme. You may lodge a query or complaint with Discovery
Health Medical Scheme by completing the online form on www.discovery.co.za or by emailing principalofficer@discovery.co.za.
3| STEP 3 – TO LODGE A DISPUTE:
If you have received a final decision from Discovery Health Medical Scheme and want to challenge it, you may lodge a formal
dispute. You can find more information of the Scheme’s dispute process on the website.
4| STEP 4 – TO CONTACT THE COUNCIL FOR MEDICAL SCHEMES:
Discovery Health Medical Scheme is regulated by the Council for Medical Schemes. You may contact the Council at any stage of the
complaints process, but we encourage you to first follow the steps above to resolve your complaint before contacting the Council.
Contact details for the Council for Medical Schemes: Council for Medical Schemes Complaints Unit, Block A, Eco Glades
2 Office Park, 420 Witch-Hazel Avenue, Eco Park, Centurion 0157 | complaints@medicalschemes.co.za | 0861 123 267 |
www.medicalschemes.co.za

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GUIDE TO PRESCRIBED

About some of the terms we use in this document

GUIDE TO PRESCRIBED MINIMUM BENEFITS

What is a Prescribed Minimum Benefit (PMB)?

Any life-threatening emergency medical condition

GUIDE TO PRESCRIBED MINIMUM BENEFITS

An example of a Prescribed Minimum Benefit (PMB) provision

PROVISION PROVISION DESCRIPTION TREATMENT ICD-10 CODE

GUIDE TO PRESCRIBED MINIMUM BENEFITS

GUIDE TO PRESCRIBED MINIMUM BENEFITS

Additional documents needed to support your application

Where to send the completed application form(s)

GUIDE TO PRESCRIBED MINIMUM BENEFITS

What happens if there is a change in your approved medicine

GUIDE TO PRESCRIBED MINIMUM BENEFITS

Nominate a GP as your primary care doctor

Cover for Cancer

Cover for HIV

GUIDE TO PRESCRIBED MINIMUM BENEFITS

Cover for COVID-19

Cover for Prescribed Minimum Benefit (PMB) admissions

GUIDE TO PRESCRIBED MINIMUM BENEFITS

Tel (members): 0860 99 88 77, Tel (health partners): 0860 44 55 66

1| STEP 1 – TO TAKE YOUR QUERY FURTHER:

2| STEP 2 – TO CONTACT THE PRINCIPAL OFFICER:

3| STEP 3 – TO LODGE A DISPUTE:

4| STEP 4 – TO CONTACT THE COUNCIL FOR MEDICAL SCHEMES:

GUIDE TO PRESCRIBED MINIMUM BENEFITS

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