If You’ve Got a PMB Chronic Condition, We Have a Plan…

Are you registered for a Prescribed Minimum Benefit (PMB) chronic condition? If so, make sure that you aren’t missing out on your OMSMAF PMB Care Plan, designed to improve your wellness and take your healthcare rand further. 

What is the PMB Care Plan? 

This is a special initiative set up by the Fund to ensure that you receive the range of benefits needed to keep your condition under control and ultimately improve your quality of life, from consultations and medical investigations to chronic medication.  

How does it work? 

Once your application for a PMB chronic condition is approved, you will receive a care plan for the PMB chronic disease that you are being treated for. Care plans vary from one condition to the next, but they all provide members with a list of the type and number of services that are generally needed by a person with your diagnosis and which the Fund will cover.  

Please take note 

Talking to your treating doctor about your PMB Care Plan is a good idea. Please bear in mind that if you need additional treatment not already included in your plan, your doctor must provide OMSMAF with a clinical motivation, which must be approved by the Fund before further services can be covered. Please also note that for non-PMB chronic conditions, OMSMAF covers approved medication but does not offer care plans.  

Please inform us of any updates and remember to request authorisation for renewal of chronic medication by email (chronic@omsmaf.co.za) so that the necessary clinical review can be done. 

Use your wellness benefits 

With OMSMAF, you have access to some of the best wellness benefits on the market.  Don’t miss out by leaving them unused, as they can go a long way to boosting your overall wellbeing and quality of life. From health screenings and vaccines to a nutritional assessment and healthy eating plan, to name just a few, we’ve got your back.  

Wellness Benefits are available across all Plans and per beneficiary each benefit year. 

Pharmacy-based Wellness Screening Benefits are available ONLY at Pharmacies that have a nurse or clinic sister on site.

Each beneficiary is allowed a blood pressure test, blood glucose, Cholesterol, HIV/AIDS, Flu Vaccine etc. Please see member guide for all other screening tests available at a Pharmacy (nurse). 

Non-Pharmacy Wellness Screening tests are those where you may have to visit either a GP or a Specialist.  

All female beneficiaries are allowed either 1 x GP consultation (paid at 100% of MSR) OR 1 Gynaecologist consultation (paid up to 200% of MSR). Please note that all 3 of these benefits must be done at the same GP/Gynaecologist visit i.e. Pap smear, Syphilis and Chlamydia infection screening and Mammogram referral.  

All male beneficiaries are allowed either 1 x GP consultation (paid at 100% of MSR) OR 1 x Urologist consultation (paid up to 200% of MSR) for a Prostate Specific Antigen (PSA) test. 

Please remember to ask your service providers to submit all Wellness tests with the ICD 10 code Z00.0.

Please see member guide for all other Wellness tests available to members and beneficiaries.

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