Prescribed Minimum Benefits
Wooltru Healthcare Fund approves funding for benefits based on treatment protocols for PMB conditions, following guidelines from healthcare authorities and best clinical practices.
Prescribed minimum benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum healthcare services, irrespective of their benefit option.
Which conditions are covered?
According to the Medical Schemes Act, medical schemes have to cover the costs related to the diagnosis, treatment and care of the following:
- The 26 common chronic health conditions on the Chronic Disease List (CDL) - see listed below.
- 270 other listed health conditions known as the Diagnosis and Treatment Pairs (DTPs). Please click here to view the 270 DTPs.
- An emergency medical condition that results in hospitalisation. Should you go to an emergency centre and the doctor does not admit you to hospital, the costs of the treatment will be paid as follows: Network Option - Emergency visit benefit; Saver, Saver Choice and Comprehensive Options - from Medical Savings Account (MSA).
Chronic conditions information leaflets
These information sheets are for your information only and is not a substitute for medical advice. The specifics of your condition and treatment should be discussed with your treating doctor to establish the optimal treatment plan for you as an individual.
Click here to read more about these chronic conditions.
| The Chronic Disease List (CDL) / 26 Prescribed Minimum Benefit (PMB) conditions |
|---|
| Addison's disease | Crohn's disease | Hypertension (high blood pressure) |
| Asthma | Diabetes insipidus | Hypothyroidism |
| Bipolar mood disorder | Diabetes mellitus types 1 & 2 | Multiple sclerosis |
| Bronchiectasis | Dysrhythmia (irregular heartbeats) | Parkinson's disease |
| Cardiac failure | Epilepsy | Rheumatoid arthritis |
| Cardiomyopathy disease (disease of the heart muscle) |
Glaucoma | Schizophrenia |
| Chronic renal disease | Haemophilia | Systemic lupus erythematosus |
| Coronary artery disease | HIV/AIDS | Ulcerative colitis |
| Chronic obstructive pulmonary disorder (COPD) | Hyperlipidaemia (high cholesterol) |