Is cancer a PMB condition?

Is cancer a PMB condition?

Cancer of solid organs qualifies as a prescribed minimum benefit (PMB) only if it is “treatable”. Thus, not all cancers of solid organs necessarily meet the requirements for PMBs. However, there are various cancers of non-solid organs and systems that qualify as PMB conditions – whether they are “treatable” or not.

Does GEMS pay for cancer treatment?

GEMS provides a comprehensive set of benefits for oncology to cover diagnosis, treatment, and palliative care. If you or one of your registered beneficiaries are diagnosed with cancer, it is important to register on the oncology management programme as soon as possible.

Can you get medical aid if you have cancer?

If a cancer is considered a PMB condition, a medical aid scheme is legally obliged to continue paying for treatment at cost, even if the oncology benefit limit has been reached. This includes covering the costs of consultations, surgery, specialised radiology, blood tests and chemo and radiation therapy.

What is PMB oncology?

If your cancer is a Prescribed Minimum Benefit (PMB) your scheme has to continue paying for treatment regardless of whether the oncology benefit has been exhausted or not. If your type of cancer is a PMB, the scheme has to pay for treatment at cost.

What are PMB benefits?

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.

Is depression a PMB condition?

Bipolar mood disorder, for instance, is eligible for PMB coverage, but other forms of depression are excluded. lt is alleged that many patients are subsequently coded as having BMD. Ditto for pneumonia (which is a PMB) and bronchitis (which is not).

What is a prescribed minimum benefit?

How do I claim money back from Gems medical aid?

You can submit your claims by:

  1. Post: GEMS, Private Bag X782, Cape Town, 8000.
  2. Fax: 0861 00 4367.
  3. Email: [email protected]; or a.
  4. GEMS walk-in centre.

Is multiple sclerosis a PMB?

Chronic Disease List condition. Multiple sclerosis is one of 26 conditions included on South Africa’s Chronic Disease List (CDL), making it eligible for prescribed minimum benefits (PMBs).

What are PMB conditions?

The Prescribed Minimum Benefit (PMB) list of conditions lists all of the conditions which all medical schemes need to cover on all the health plans they offer to their members. This cover includes funding for the diagnosis, treatment and ongoing care for the listed conditions.

What is a major affective disorder?

Affective disorders are a set of psychiatric disorders, also called mood disorders. The main types of affective disorders are depression and bipolar disorder. Symptoms vary by individual and can range from mild to severe. A psychiatrist or other trained mental health professional can diagnose an affective disorder.

What does day to day benefits mean?

Day-to-day benefits refer to out-of-hospital care that happens on a more frequent basis which may include dentistry, optometry, GP visits and medication. Day-to-day benefits differ from one scheme to the other. Many healthcare providers offer little to no day-to-day cover with greater focus on in-hospital treatment.

When can I start using my medical aid?

According to the Medical Schemes Act, medical aid schemes are entitled to impose a 3 months general waiting period and / or a 12 months condition specific waiting period(s) for any pre-existing medical condition(s). The Act makes specific provision for the imposition of waiting periods (and late joiner penalties).

How do I check my gem benefits?

SMS Benefit Check

  1. Step 1: Type Benefit.
  2. Step 2: Type your GEMS membership number.
  3. Step 3: Choose the benefit you want to check from the table below (remember you can only check one benefit category per SMS).