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Prescribed Minimum Benefits

For every medical scheme member it is important to know the following:

According to the Medical Scheme Act of 2000, An emergency medical condition is the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person's life in serious jeopardy.

Code Condition Treatment
906a acute generalised paralysis, including polio and guillain-barre medical management; ventilation and plasmapheresis
341a basal ganglia, extra-pyramidal disorders; other dystonias nos initial diagnosis; initiation of medical management
950a benign and malignant brain tumours, treatable medical and surgical management, which includes radiation therapy and chemotherapy
49a compound/depressed fractures of skull craniotomy/craniectomy
213a difficulty in breathing, eating, swallowing, bowel, or bladder control due to non-progressive neurological (including spinal) condition or injury medical and surgical management; ventilation
83a encephalocele; congenital hydrocephalus shunt; surgery
902a epilepsy (status epilepticus, initial diagnosis, candidate for neurosurgery) medical management; ventilation; neurosurgery
211a intrasp1nal and intracranial abscess medical and surgical management
905a meningitis - acute and subacute medical and surgical management
513a myasthenia gravis; muscular dystrophy; neuro-myopathies nos initial diagnosis; initiation of medical management; therapy for acute complications and exacerbations
510a peripheral nerve injury with open wound neuroplasty
940a reversible cns abnormalities due to other systemic disease medical and surgical management
1a severe/moderate head injury: hematoma/edema with loss of consciousness medical and surgical management; ventilation
1ma spina bifida surgical management
941a spinal cord compression, ishaemia or degenerative disease nos medical and surgical management
901a stroke - due to haemorrhage, or ischaemia medical management; surgery
28a subarachnoid and intracranial hemorrhage/hematoma; compression of brain medical and surgical management
305a tetanus medical management; ventilation
265a transient cerebral ischemia; life-threatening cerebrovascular conditions nos evaluation; medical management; surgery
109a vertebral dislocations/fractures, open or closed with injury to spinal cord repair/reconstruction; medical management; inpatient rehabilitation up to 2 months
684a viral meningitis, encephautis, myelitis and encephalomyelitis medical management
47b acute orbital cellulitis medical and surgical management
394b angle-closure glaucoma iridectomy; laser surgery; medical and surgical management
586b bell's palsy; exposure keratoconjunctivitis tarsorrhaphy; medical and surgical management
950b cancer of eye & orbit - treatable medical and surgical management, which includes radiation therapy and chemotherapy
901 b cataract; aphakia extraction of cataract; lens implant
911b corneal ulcer; superficial injury of eye and adnexa conjunctival flap; medical management
4058 glaucoma associated with disorders of the lens surgical management
386b herpes zoster & herpes simplex with ophthalmic complications medical management
389b hyphema removal of blood clot; observation
4858 inflammation of lacrimal passages incision; medical management
909b open wound of eyeball and other eye structures medical and surgical management
407b primary and open angle glaucoma with failed medical management trabeculectomy; other surgery
4198 purulent endophthalmitis vitrectomy
922b retained intraocular foreign body surgical management
904b retinal detachment, tear and other retinal disorders vitrectomy; laser treatment; other surgery
906b retinal vascular occlusion; central retinal vein occlusion laser surgery
4098 sympathetic uveitis and degenerative disorders and conditions of globe; sight threatening thyroid optopathy enucleation; medical management; surgery ear, nose, mouth and throat
33c acute and chronic mastoiditis mastoidectomy; medical management
482c acute otitis media medical and surgical management, including myringotomy
900c acute upper airway obstruction, including croup, epiglottitis and acute laryngotracheitis medical management; intubation; tracheostomy
950c cancer of oral cavity, pharynx, nose, ear, and larynx - treatable. medical and surgical management, which includes chemotherapy and radiation therapy
241c cancrum oris medical and surgical management
38c choanal atresia repair of choanal atresia
133c cholesteatoma medical and surgical management
910c chronic upper airway obstruction, resulting in corpulmonale surgical and medical management
901c cleft palate and/or cleft lip without airway obstruction repair
12c deep open wound of neck, including larynx; fracture of larynx or trachea, open medical and surgical management; ventilation
346c epistaxis - not responsive to anterior packing cauiery / repair / control hemorrhage
521c foreign body in ear & nose removal of foreign body; and medical and surgical management
29c foreign body in pharynx, larynx, trachea, bronchus & esophagus removal of foreign body
339c fracture of face bones, orbit, jaw; injury to optic and other cranial nerves medical and surgical management
219c leukoplakia of oral mucosa, including tongue incision/excision; medical management.
132c life-threatening diseases of pharynx nos, including retropharyngeal abscess medical and surgical management
457c open wound of ear-drum tympanoplasty; medical management
240c peritonsillar abscess incision and drainage of abscess; tonsillectomy; medical management
347c sialoadenitis; abscess / fistula of salivary glands surgery
543c stomatitis, cellulitis and abscess of oral soft tissue; vincents angina incision and drainage; medical management respiratory system
903d bacterial, viral, fungal pneumonia medical management, ventilation.
158d respiratory failure, regardless of cause medical management; oxygen; ventilation
157d acute asthmatic auack; pneumonia due to respiratory syncytial virus in persons under age 3 medical management
125d adult respiratory distress syndrome; inhalation and aspiration pneumonias medical management; ventilation
315d atelectasis (collapse of lung) medical and surgical management; ventilation
mod benign neoplasm of respiratory and intrathoracic organs biopsy; lobectomy; medical management; radiation therapy
950d cancer of lung, bronchus, pleura, trachea, mediastinum & other respiratory organs -treatable medical and surgical management, which includes chemotherapy and radiation therapy
1 7od empyema and abscess of lung medical and surgical management
934d frank haemoptyisis medical and surgical management
2o3d hypoplasia and dysplasia of lung medical and surgical management
900d open fracture of ribs and sternum; multiple rib fractures; flail chest medical and surgical management, ventilation
sd pneumothorax and haemothorax. tube thoracostomy / thoracotomy
heart and vasculature
155e myocarditis; cardiomyopathy; transposition of great vessels; hypoplastic left heart syndrome. medical and surgical management; cardiac transplant
108e pericarditis medical and surgical management
907e acute and subacute ischemic heart disease, including myocardial infarction and unstable angina medical management; surgery; percutaneous procedures
284e acute pulmonary heart disease and pulmonary emboli medical and surgical management
35e acute rheumatic fever medical management
908e aneurysm of major artery of chest, abdomeni neck, -unruptured or ruptured nos surgical management
26e arterial embolism/thrombosis: abdominal aorta, thorac1c aorta medical and surgical management
204e cardiac failure: acute or recent deterioration of chronic cardiac failure medicaltreatment
98e complete, corrected and other transpostion of great vessels repair
97e coronary artery anomaly anomalous coronary artery ligation
309e diseases and disorders of aortic valve nos aortic valve replacement
210e diseases of endocardium; endocarditis medical management
314e diseases of mitral valve valvuloplasty; valve replacement; medical management
902e disorders of arteries: visceral bypass graft; surgical management
18e dissecting or ruptured aortic aneurysm surgical management
915e gangrene; severe atherosclerosis of arteries of extremities; diabetes mellitus with peripheral circulatory disease medical and surgical management including amputation
294e giant cell arteritis, kawasaki disease, hypersensitivity angiitis medical management
450e hereditary hemorrhagic telangiectasia excision
901e hypertension - acute life-threatening complications and malignant hypertension; renal artery stenosis and other curable hypertension medical and surgical management
111e injury to major blood vessels - trunk, head and neck, and upper limbs repair