AG
Adri G
1 reviews | Active since Mar 2024
07 Aug 2015, 11:19
How
How is it possible that you pay R6000 + per month for a medical aid per month and then you have to pay R3300 for medication per month. <br> <br> Sorry we approve you chronic condition but please do not ask for pain medicine we don't do pain medicine.<br> <br> <br>
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Discovery Health's replyOfficial
13 Aug 2015, 15:50Hello FrancinaG,
Thank you for your comment.
Prescribed Minimum Benefits (PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.
For instances where the medication does not form part of the CIB medication formulary the member does not have access to full cover. When we design the CIB formulary, we make evidence-based, thoroughly researched decisions regarding which medications to include on the formulary. We also use specific clinical entry criteria when approving or declining access to CIB cover. Each plan has associated with it a medicine list which is covered in full, as well as a Chronic Drug Amount (CDA) allowing members to use medicines not on the list.
I understand that this may not be satisfied with the outcome however it is in line with the Scheme rules.
Regards
Jashvir
Thank you for your comment.
Prescribed Minimum Benefits (PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.
For instances where the medication does not form part of the CIB medication formulary the member does not have access to full cover. When we design the CIB formulary, we make evidence-based, thoroughly researched decisions regarding which medications to include on the formulary. We also use specific clinical entry criteria when approving or declining access to CIB cover. Each plan has associated with it a medicine list which is covered in full, as well as a Chronic Drug Amount (CDA) allowing members to use medicines not on the list.
I understand that this may not be satisfied with the outcome however it is in line with the Scheme rules.
Regards
Jashvir
Discovery Health's reply13 Aug 2015, 15:50
Official
Hello FrancinaG,
Thank you for your comment.
Prescribed Minimum Benefits (PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.
For instances where the medication does not form part of the CIB medication formulary the member does not have access to full cover. When we design the CIB formulary, we make evidence-based, thoroughly researched decisions regarding which medications to include on the formulary. We also use specific clinical entry criteria when approving or declining access to CIB cover. Each plan has associated with it a medicine list which is covered in full, as well as a Chronic Drug Amount (CDA) allowing members to use medicines not on the list.
I understand that this may not be satisfied with the outcome however it is in line with the Scheme rules.
Regards
Jashvir
Thank you for your comment.
Prescribed Minimum Benefits (PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.
For instances where the medication does not form part of the CIB medication formulary the member does not have access to full cover. When we design the CIB formulary, we make evidence-based, thoroughly researched decisions regarding which medications to include on the formulary. We also use specific clinical entry criteria when approving or declining access to CIB cover. Each plan has associated with it a medicine list which is covered in full, as well as a Chronic Drug Amount (CDA) allowing members to use medicines not on the list.
I understand that this may not be satisfied with the outcome however it is in line with the Scheme rules.
Regards
Jashvir