Prescribed Minimum Benefits (PMBs) 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 condensed list below, from Discovery Health’s website (2024), indicates which conditions we are able to apply for, and in which way treatment can be provided:
| PMB Description |
Treatment |
|
Acute delusional mood, anxiety, personality, perception disorders and organic mental disorder caused by drugs
|
Hospital admission for psychotherapy/counselling up to three days, or up to 12 outpatient psychotherapy/counselling contacts
|
|
Anorexia Nervosa and Bulimia Nervosa
|
Hospital-based management up to three weeks/year or minimum of 15 outpatient contacts per year
|
| Attempted suicide, irrespective of cause |
Hospital-based management up to three days or up to 6 outpatient contacts
|
|
Major affective disorders, including unipolar and bipolar depression
|
Hospital-based management up to three weeks/year (including inpatient electro-convulsive therapy and inpatient psychotherapy) or outpatient psychotherapy of up to 15 contacts
|
It is important to understand the following:
- 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 an initial consultation and assessment.
- If a successful PMB application has been made, PMB sessions are shared between the treating psychiatrist and psychologist.
- PMB applications require the disclosure of the diagnosed condition. You should be aware that there may be implications for having a diagnosis on record. These may include exclusion criteria being applied to life insurance policies, loaded policy premiums, challenges with emigration, career limitations, etc.
- If we use outpatient sessions for treatment, and you require an inpatient admission later in the year, you may not have access to this through the PMB, as we would have used a portion, or all of the benefit for therapy.
We have discussed your needs, and I do believe that you or your child meets the criteria for one of the conditions listed above. For this reason, we are able to apply for a PMB for the number of sessions as listed above, should you wish to.