It’s a new year and many need to re-apply for their mental health PMB’s for the year or some need to go for a mental health screening that might need a PMB application, what does PMB mean?
PMB’s stand for Prescribed Minimum Benefits. They are a set of healthcare services that medical schemes or insurance plans are legally required to cover for their members in certain countries. PMBs typically include a list of defined medical conditions and treatments that must be covered by medical aid schemes, regardless of the specific plan or level of coverage the member has.
PMBs are designed to ensure that individuals have access to essential healthcare services and treatments, especially for serious or life-threatening conditions. They cover a range of services, including emergency care, certain chronic conditions, and treatments for specific illnesses that have been identified as critical by healthcare authorities.
In the context of health insurance, PMBs are mandated to prevent discrimination against individuals with certain health conditions and to ensure that they receive necessary and adequate treatment as prescribed by law, irrespective of their financial plan or level of coverage within a medical scheme.
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 list below, from Discovery Health’s website, indicates which psychological conditions one is able to apply for, and in which way treatment coverage can be provided:
It is important to understand the following:
Health professionals can only apply for a PMB for a client 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 one’s treating psychiatrist and psychologist. Only psychologists, psychiatrists and doctors can apply for a PMB. It is only in the scope of a registered counsellor to do screening and to refer appropriately.
If a client has used their out of hospital PMB and needs a hospital admission for the diagnosed condition, the medical aid will not cover the in-patient treatment. For example, for a mood disorder, the benefit is EITHER 15 out of hospital appointments (with a psychologist/ psychiatrist) OR a three week hospital admission (not both).
It is the client’s responsibility to keep track of the number of sessions used and those still available. Once these sessions have been used up, medical aid savings can be used to cover the cost of sessions. Once a client has exhausted both PMB and savings benefits, a cash rate will be applied for future sessions.
PMB applications require this disclosure of the diagnosed condition. Clients need to be cognizant 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.
Before commencing with the application for a PMB, it is important that one carefully considers any possible consequences of such an application mentioned above.
Should one wish to apply for a PMB, there are a number of ways in which these sessions can be used so as to maximise the use of the benefit.
Don’t hesitate to get in touch with me for an online counselling session in January 2024. Let’s together create an environment where you can connect with yourself again, an environment that fosters and encourages authenticity. An environment where you can follow your gut and get to know what it looks like.
After doing an intake I might be able to help you with a few sessions using BWRT (Brainworking Recursive Therapy) read more about BWRT on another blog on my website: https://thewellsamaria.co.za/what-is-brainworking-recursive-therapy-or-bwrt/, or we will use another technique depending on your unique needs.
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