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List of PMB conditions: Mental Illness

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PMB list

Below is a list of the PMB condition treatment pairs for Brain and Nervous System.. Your medical aid has to pay for the treatment, and cannot use funds from your savings, even if the treatment is given out-of-hospital.

To see the rest of the 270 PMB conditions, please see our “List of PMBs” page.

For an explanation of general treatments (example: “Medical Management”) please read our explainer.

Mental Illness

CODE CONDITION TREATMENT
182T Abuse or dependence on Psychoactive substance, including alcohol Hospital-based management up to 3 weeks/year
910T Acute delusional mood, anxiety, personality, perception disorders and organic mental disorder caused by drugs Hospital-based management up to 3 days
901T Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse Hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
910T Alcohol withdrawal delirium; alcohol intoxication delirium Hospital-based management up to 3 days leading to rehabilitation
908T Anorexia Nervosa and Bulimia Nervosa Hospital-based management up to 3 weeks/year or minimum of 15 outpatient contacts per year
903T Attempted suicide, irrespective of cause Hospital-based management up to 3 days or up to 6 outpatient contacts
184T Brief reactive psychosis Hospital-based management up to 3 weeks/year
910T Delirium: Amphetamine, Cocaine, or other psychoactive substance Hospital-based management up to 3 days
902T Major affective disorders, including unipolar and bipolar depression Hospital-based management up to 3 weeks/year (including inpatient electro-convulsive therapy and inpatient psychotherapy) or outpatient psychotherapy of up to 15 contacts
907T Schizophrenic and paranoid delusional disorders Hospital-based management up to 3 weeks/year
909T Treatable dementia Admission for initial diagnosis; management of acute psychotic symptoms – up to 1 week

To see the rest of the 270 PMB conditions, please see our “List of PMBs” page.

How does your medial aid plan cover this benefit?

What you see above is the minimum level of cover for each condition. Medical aids can offer more benefits than the limits above.

To see how your plan pays out for a condition, find your plan here, and view your plan’s full benefits.

You can also compare any two medical aid plans side by side, to see which one suits your needs best.

Remember, a medical aid can still impose conditions on how PMBs are treated. For example, the scheme can impose network service providers (DSPs), a medicine formulary or even require that you be treated in a state hospital. You can read a full explanation on how medical aids must pay for PMBs here.

There’s more help here:

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