Did you know that anaphylaxis is one of the medical conditions listed for prescribed minimum benefits or “PMB’s”?
The Medical Schemes Act states that medical schemes must cover the full cost related to the diagnosis, treatment and care of certain listed medical conditions, one of which is Anaphylaxis.
This ensures that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected.
If you have been diagnosed with anaphylaxis, and have been prescribed an epipen, ask your doctor to complete a PMB application.
Your medical scheme might require additional supporting documentation from you or your doctor before they approve the application.
If you do qualify, your medical aid will be obliged to cover the cost of your diagnosis, treatment and medication for this condition in full, with no co-payments or deductibles.
The costs must be covered from the PMB benefit and cannot be deducted from your medical savings account. This applies to all individuals who are members of a medical scheme, even if they are on a hospital plan only.
See our AFSA video on Faces of Anaphylaxis