Prescribed Minimum Benefits Made Clear – Free Guide

Description

Do you know what your medical scheme must cover as a Prescribed Minimum Benefit—or what to do when a qualifying claim is declined? Prescribed Minimum Benefits Made Clear is a free, plain-language South African guide explaining how Prescribed Minimum Benefits work. The guide covers:

• the three parts of Prescribed Minimum Benefits;
• what legally qualifies as an emergency medical condition;
• how Diagnosis Treatment Pairs work;
• the 26 Chronic Disease List conditions;
• Designated Service Providers, treatment protocols and medicine formularies;
• authorisation, registration and the records you should retain;
• waiting periods and Prescribed Minimum Benefits; and
• the steps to follow when a claim is declined.

The guide also includes practical checklists for planned treatment, emergency treatment and medical-scheme disputes. Price: Free General educational information only. This guide does not constitute personalised medical, financial, legal or medical-scheme advice. Benefits depend on the confirmed diagnosis, prescribed treatment, applicable legislation and the registered rules of the relevant medical scheme. Abbreviations used: PMB – Prescribed Minimum Benefit; DTP – Diagnosis Treatment Pair; CDL – Chronic Disease List; DSP – Designated Service Provider.