Prescribed Minimum Benefits (PMBs) are a list of diseases or conditions listed in the Medical Schemes Act which all medical schemes are required to fund. Included in this is the Chronic Disease List (CDL) of chronic conditions that also fall under the umbrella of PMBs. For a list of which conditions are considered PMBs by the Act, simply click here
One of the types of codes that appear on healthcare provider accounts is known as ICD-10 codes. These codes are used to inform medical schemes about what conditions their members were treated for so that claims can be settled correctly. ICD-10 stands for International Classification of Diseases and Related Health Problems (10th revision). It is a coding system developed by the World Health Organisation (WHO) that translates the written description of medical and health information into standard codes. It’s therefore important that these codes are always on your claims so that the medical scheme knows which benefit to pay the account from.
A Designated Service Provider (DSP) is a contracted medical service provider who we have negotiated a set pricing with. We do this because it limits medical inflation and ultimately allows us to contain contribution increases as far as possible. In some cases, using a non-DSP provider will mean you have to pay towards your healthcare, so it is in your interests to avoid out of pocket payments by using a DSP for your healthcare needs wherever possible.
Our Pharmaceutical Benefit Management (PBM) system is a tailor-made medicine authorisation and medicine claims adjudication system that simplifies your medicine authorisation process on some medicines, making it easier and more convenient for you to get the care you need.
The Chronic Disease List (CDL) is a list of specific chronic conditions and their treatment and management as published by the Minister of Health in the Government Gazette. For a list of the chronic conditions covered on your Resolution Health option, consult your specific benefit option guide.