Prescribed minimum benefits (PMB's) 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.
The lists of conditions are:
- Acute delusional mood, anxiety, personality, perception disorders and organic mental disorders caused by drugs.
- Anorexia Nervosa and Bulimia Nervosa.
- Attempted suicide, irrespective of cause.
- Major affective disorders, including unipolar and bi-polar depression.
It is important to understand the following:
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Health professionals can only apply for a PMB for a patient if they meet the diagnostic criteria for one of the conditions specified on the list. One cannot diagnose a condition that is not present, nor can an application be made without initial consultation and assessment.
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If a successful PMB application has been made, PMB sessions are shared between the psychologist and psychiatrist (if one is involved).
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PMB requires disclosure of the condition. You should be aware that there may be implications for having a diagnosis on record which may include exclusion criteria being applied to life insurance, challenges with emigration, etc.
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If you have used these sessions for treatment and later require inpatient admission in the year, then you may not have access to these through the PMB.