PMBs and Mental Conditions: what does medical aid cover?

PMB Mental Health conditions

Need more information on PMBs?

These PMB mental conditions must be covered by medical aids without charging the member out-of-pocket expenses, assuming that protocols and DSPs (Designated Service Providers) are followed.

CODECONDITIONTREATMENT
182TAbuse or dependence on Psychoactive substance, including alcoholHospital-based management up to 3 weeks/year
910TAcute delusional mood, anxiety, personality, perception disorders and organic mental disorder caused by drugsHospital-based management up to 3 days
901TAcute stress disorder accompanied by recent significant trauma, including physical or sexual abuseHospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
910TAlcohol withdrawal delirium; alcohol intoxication deliriumHospital-based management up to 3 days leading to rehabilitation
908TAnorexia Nervosa and Bulimia NervosaHospital-based management up to 3 weeks/year or minimum of 15 outpatient contacts per year
903TAttempted suicide, irrespective of causeHospital-based management up to 3 days or up to 6 outpatient contacts
184TBrief reactive psychosisHospital-based management up to 3 weeks/year
910TDelirium: Amphetamine, Cocaine, or other psychoactive substance Hospital-based management up to 3 days
902TMajor affective disorders, including unipolar and bipolar depressionHospital-based management up to 3 weeks/year (including inpatient electro-convulsive therapy and inpatient psychotherapy) or outpatient psychotherapy of up to 15 contacts
907TSchizophrenic and paranoid delusional disordersHospital-based management up to 3 weeks/year
909TTreatable dementiaAdmission for initial diagnosis; management of acute psychotic symptoms – up to 1 week

Pssst...want to hear a secret?

Medical Aids don't like us very much! We call out all the BS, and always put YOU first. Find out all the things (some) medical aids don't want you to know.

(Bonus! We also talk about all the great stuff the schemes do!)

Quick Links

test