Issue link: https://www.hub.camaf.co.za/i/1512931
2024 FIRST CHOICE 09 Benefits As a minimum requirement, all CAMAF members have, included in their benefits, all PMBs as well as other benefits - see below: PMBs Prescribed Minimum Benefits (PMB) as set down in the Medical Schemes Act, 1998. Medical schemes have to cover the costs related to the diagnosis, treatment and care of: • Any emergency condition. • A limited set of 271 medical conditions, as defined in the Diagnosis and Treatment Pairs (DTP*). • 27 chronic conditions, defined in the Chronic Disease List (CDL). DTP *DTP - the protocols for the treatment and care of PMB conditions should be based on healthcare that has proven to work best, taking affordability into consideration. The minimum standard is the practice and protocol applied in the public sector; however, schemes have the option of providing more extensive care. Such costs may not be paid from a member's savings benefit. Cost saving measures can be used by way of utilising DSPs, Reference pricing and formularies and "evidence based" treatment protocols. IN HOSPITAL Benefit and Extent of Cover Hospital Unlimited, hospital benefits - paid at 100% negotiated rate for general and specialised wards - subject to pre authorisation Services in Hospital Service providers paid up to 100% of CBT* in a general ward unless a more specialised ward is medically indicated Choice Freedom of choice of service providers and hospitals Childbirth Confinements Up to 100% CBT in a general ward Co-payments No scheme imposed co-payments on surgery or procedures Infertility Treatment PMB only Radiology and Pathology Limited Radiology and Pathology - in or out of hospital Emergency Evacuation Unlimited emergency evacuation – Netcare 911 Additional Chronic Conditions Depression only 2024 FIRST CHOICE BACK TO CONTENTS PAGE