Mental ill-health becoming more prevalent, and more people are identifying illnesses that need treating.
Both government and private mental health professionals and facilities are in high demand in South Africa, making it extremely difficult to access care in public facilities, while waiting times and costs for private facilities are high. Mental health conditions that are covered by the PMB chronic condition list include Schizophrenia and Bipolar affective disorder. For these conditions, the diagnosis, care and ongoing medication must be covered by your scheme.
Anorexia nervosa and bulimia nervosa: up to three weeks treatment in hospital per year or 15 consultations as an outpatient; Unfortunately, benefits are often hopelessly inadequate for the treatment required for serious, often life-threatening, mental health conditions that require long periods in mental health facilities as well as ongoing outpatient consultations with both psychiatrists and psychologists.In order to enjoy these benefits you may need to apply for approval of the PMB, particularly if it is out-of-hospital treatment.
Some schemes have allied, therapeutic and psychology benefit limits that pay from your day-to-day benefits or medical savings accounts. If you have above-threshold benefits, you have to pay out-of-pocket when you are in the self-payment gap but benefits are paid again at the scheme rate when your expenses exceed the threshold.
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