What are the PMB conditions?

The Chronic Disease List (CDL) specifies medication and treatment for the 25 chronic conditions that are covered in this section of the PMBs:

• Chronic renal disease.
• Addison’s disease.
• Asthma.
• Bronchiectasis.
• Cardiac failure.
• Cardiomyopathy.
• Chronic obstructive pulmonary disorder.
• Coronary artery disease.

What is PMB level of care?

All underlying pre-existing comorbid chronic conditions such as diabetes mellitus, HIV, asthma etc, should be managed as per the corresponding Diagnostic Treatment Pair (DTP) and/ or Chronic Disease List (CDL) are deemed PMB level of care.

What are Discovery prescribed minimum benefits?

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.

What is a PMB condition discovery?

The Prescribed Minimum Benefit (PMB) list of conditions lists all of the conditions which all medical schemes need to cover on all the health plans they offer to their members. This cover includes funding for the diagnosis, treatment and ongoing care for the listed conditions.

What are the most expensive diseases to treat?

Cardiovascular disease includes coronary heart disease ($89 billion), high blood pressure ($68 billion), and stroke ($37 billion) as the 3 top cost generators, according to AHA.

Is depression a PMB?

Bipolar mood disorder, for instance, is eligible for PMB coverage, but other forms of depression are excluded.

Is lupus a PMB?

Lupus is an autoimmune disease that attacks joints and vital organs such as the kidneys, lungs, brain and heart. Discovery’s PMB benefits for lupus include four consultations with specialists and a limited number of blood tests a year. The scheme only covers the cost in full of specialists on its specialist list.

What is the waiting period for discovery?

Discovery Health Medical Scheme’s general waiting period is for three consecutive months, while the condition-specific waiting period is 12 consecutive months. The table below gives more information about the type of waiting period that we may apply.

What is the most costly disease?

According to the CDC, heart disease and stroke remain the most expensive chronic diseases for the healthcare system. It causes a third of all deaths in America on a yearly basis and costs the healthcare system $199 billion.

What are the top 10 chronic health conditions?

The top 10 most expensive chronic diseases for healthcare payers eat up significant healthcare dollars.

• Alcohol-related health issues.
• Diabetes.
• Alzheimer’s disease.
• Cancer.
• Obesity.
• Arthritis.
• Asthma.
• Stroke.

How many PMB’s are there in the world?

There are 270+ PMB conditions, for which your medial aid must cover diagnosis, treatment and management, in and out of hospital. You can read more about PMBs here.

Which is the most common chronic PMB condition?

Chronic PMB conditions 1 Addison’s Disease 2 Asthma 3 Bipolar Mood Disorder 4 Bronchiectasis 5 Cardiac Failure 6 Cardiomyopathy 7 Chronic Renal Disease 8 Chronic Obstructive Pulmonary Disease 9 Coronary Artery Disease 10 Crohn’s Disease

Do you have to pay for PMB treatment?

PMB (Prescribed Minimum Benefits) conditions, including chronic PMB conditions, are conditions that all medical aids need to pay for, regardless of what plan you are on. No savings should be used to pay for diagnosis, treatment and management of the condition, and there should be no co-payments.

Are there any medical insurance exclusions for PMBs?

Medical schemes often have a list of conditions – such as cosmetic surgery – for which they will not pay, or circumstances – such as travel costs and examinations for insurance purposes – under which a member has no cover. These are called exclusions. Exclusions, however, do not apply to PMBs.

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