PMBs and Mental Conditions: what does medical aid cover?

PMB Mental Health conditions

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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.

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

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