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06 July 2011

Which conditions are covered?

The Regulations to the Medical Schemes Act in Annexure A provide a long list of conditions identified as Prescribed Minimum Benefits.

The Regulations to the Medical Schemes Act in Annexure A provide a long list of conditions identified as Prescribed Minimum Benefits. The list is in the form of Diagnosis and Treatment Pairs (DTPs).

Here is an example of a DTP as it appears in the Medical Schemes Act:

Code Diagnosis Treatment
109A Vertebral dislocations/fractures, open or closed with injury to spinal cord Repair/reconstruction; medical management; inpatient rehabilitation up to two months

PMB category Example
Brain and nervous system Stroke
Eye Glaucoma
Ear, nose and throat Cancer of oral cavity, pharynx, nose, ear and larynx
Respiratory system Pneumonia
Heart and vasculature (blood vessels) Heart attacks
Gastro-intestinal system Appendicitis
Liver, pancreas and spleen Gallstones with cholecystisis
Musculoskeletal system (muscles and bones); Trauma NOS Fracture of the hip
Skin and breast Treatable breast cancer
Endocrine, metabolic and nutritional Disorders of the parathyroid gland
Urinary and male gential system End-stage kidney disease
Female reproductve system Cancer of the cervix, ovaries and uterus
Pregnancy and childbirth Antenatal and obstetric care requiring hospitalisation, including delivery
Haematological, infectious and miscellanous systemic conditions HIV/Aids and TB
Mental illness Schizophrenia
Chronic conditions Asthma, diabetes, epilepsy, Asthma, diabetes, epilepsy, hypothyroidism, schizophrenia, glaucoma, hypertension

 
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