Prescribed Minimum Benefit Treatment Baskets 08 Who are Glencore Medical Scheme (referred to as 'the Scheme"), registration number 5, is a non-profit organisation, registered with the Council for Medical Schemes. Discovery Health (Pty) Ltd (referred to as "the administrator"), is a separate company and an authorised financial services provider (registration number 997/080/07). We take care of the administration of your membership for the Scheme. Treatment baskets for the Prescribed Minimum Benefit Chronic Disease List conditions The Prescribed Minimum Benefit Chronic Disease List is a list of chronic conditions which all medical schemes need to cover on all the plans they offer to their members. This cover includes funding for the diagnosis, treatment and ongoing care for the listed conditions. Read further to understand what procedures, investigations and are covered for both the diagnosis and ongoing management for each condition. We will only pay Prescribed Minimum Benefit claims if your chronic condition has been approved on the Chronic Illness Benefit Only claims for procedures and listed in the Prescribed Minimum Benefit (PMB) treatment baskets will be paid from the Chronic Illness Benefit. These are pro-rated based on the date of approval of your chronic condition. We will pay s and procedures for your condition according to the treatment baskets We pay certain s like blood s and x-rays according to the PMB treatment baskets. This cover includes s and procedures for both the diagnosis and ongoing management for each of the PMB Chronic Disease List conditions. We pay listed blood s, scans and x-rays up to a maximum of the Scheme Rate. How pay GP related to your condition We pay for four () that are related to your approved condition a at any GP. We pay for with a GP in full without any co-payments.
How pay specialist related to your condition Depending on your condition, pay for a specific number of with a specialist as listed in the treatment baskets. We will pay the consultation at a specialist in full without any co-payments. Please make sure your claims have the appropriate ICD-0 code All claims must have the appropriate ICD-0 (diagnostic ) so that can identify them and pay them from the Chronic Illness Benefit. We will not pay claims from the chronic benefit if these requirements are not met We will not pay claims from the chronic benefit if: The claims are submitted without the relevant ICD-0 ; You are not yet registered on the Chronic Illness Benefit for a PMB condition; You have exceeded the frequency limit on or s. Contact us You can call us on 0860 00 or visit www.glencoremedicalscheme.co.za for more information. Page of 05/08
Treatment baskets for Chronic Disease List conditions Condition Diagnostic Ongoing management Addison s disease description follow-up s each U & E only 7 U & E only 7 or Cortisol level 99 ACTH stimulation ing 5 Asthma Flow volume 88 or 86 Bipolar mood disorder Bronchiectasis or Flow volume 88 or 86 Peak flow 9 Peak flow 9 AST Aspartate ALT Alanine 0 AST Aspartate ALT Alanine 0 Thyrotropin (TSH) 507 Thyrotropin (TSH) 507 U & E only 7 U & E only 7 Sputum MC&S sputum analysis for infection Flow volume 867 & 88 & 885 & 887 & 895 & 9 & 9 88 or 86 Lithium flame ionisation 067 Drug level in biological Sputum MC&S sputum analysis for infection 08 or 70 or 9 or 867 & 88 & 885 & 887 & 895 & 9 & 9 Flow volume 86 Peak flow 9 Peak flow 9 Cardiac failure ECG Electrocardiogram or or or 5 or 6 Echocardiography 00 6 & 6 & 6 & 60 & 65 ECG Electrocardiogram or or or 5 or 6 Echocardiography 6 & 6 & 6 & 60 & 65 U & E only 7 U & E only 7 Urine analysis (dipstick) 88 Urine analysis (dipstick) 88 Page of 05/08
Condition Diagnostic Ongoing management description follow-up s each Cardiac failure B-Type natriuretic peptide 88 B-Type natriuretic peptide 88 or or 00 Troponin isoforms 6 Drug level in biological Glucose random/fasting 057 C-reactive protein 97 Full blood count 755 Thyrotropin (TSH) 507 Total cholesterol 07 Cardiomyopathy ECG Electrocardiogram Chronic obstructive pulmonary disease (COPD) Chronic renal disease Echocardiography or or or 5 or 6 6 & 6 & 6 & 60 & 65 00 08 or 70 or 9 ECG Electrocardiogram or or or 5 or 6 Echocardiography 6 & 6 & 6 & 60 & 65 U & E only 7 U & E only 7 Urine analysis (dipstick) 88 Urine analysis (dipstick) 88 B-Type natriuretic peptide 88 B-Type natriuretic peptide 88 or or 00 00 Glucose random/fasting 057 Prothrombin index (PI) 805 C-reactive protein 97 Therapeutic drug level: Dosage Full blood count 755 Drug level in biological Thyrotropin (TSH) 507 Total cholesterol 07 Flow volume 88 or 86 806 08 or 70 or 9 Flow volume 86 00 Peak flow 9 Alpha--antitrypsin 005 Drug level in biological ECG Electrocardiogram or or 6 08 or 70 or 9 ECG Electrocardiogram or or 6 Page of 05/08
Condition Diagnostic Ongoing management Chronic renal disease Coronary artery disease description follow-up s each Full blood count 755 Full blood count 755 U & E only 7 U & E only 7 Serum calcium Serum phosphates Serum parathyroid hormone (PTH) or 06 or 07 or 75 or 76 09 or or Serum calcium 06 or 07 or 75 or 76 Serum phosphates 09 or 5 Serum parathyroid hormone (PTH) 5 Protein: Quantitative Protein: Quantitative ECG Electrocardiogram Echocardiography or or or 5 or 6 6 & 6 & 6 & 60 & 65 or Platelet count 797 Urine analysis (dipstick) 88 Iron 07 Transferrin Ferritin 58 ECG Electrocardiogram or or or 5 or 6 Echocardiography 6 & 6 & 6 & 60 & 65 or U & E only 7 U & E only 7 Glucose random/fasting 057 Glucose random/fasting 057 Total cholesterol 07 Total cholesterol 07 LDL cholesterol 06 LDL cholesterol 06 HDL cholesterol 08 HDL cholesterol 08 Triglycerides 7 Triglycerides 7 C-reactive protein 97 Urine analysis (dipstick) 88 Full blood count 755 Thyrotropin (TSH) 507 00 Platelet count 797 Page 5 of 05/08
Condition Diagnostic Ongoing management Crohn s disease Colonoscopy 65 or 656 Diabetes insipidus Erythrocyte sedimentation rate or C-reactive protein 7 or 97 description Colonoscopy 65 or 656 follow-up s each C-reactive protein 97 Full blood count 755 Full blood count 755 Histology 567 & 57 or 58 & 58 U & E only 7 U & E only 7 Osmolality: Serum or urine or Diabetes type ECG Electrocardiogram or or 6 Microalbuminuria or 09 Osmolality: Serum or urine 09 6 or 6 ECG Electrocardiogram or or 6 Microalbuminuria 6 or 6 Urine analysis (dipstick) 88 Urine analysis (dipstick) 88 Total cholesterol 07 Total cholesterol 07 LDL cholesterol 06 LDL cholesterol 06 HDL cholesterol 08 HDL cholesterol 08 Triglycerides 7 Triglycerides 7 U & E only 7 U & E only 7 Serum creatinine Serum creatinine Urine creatinine Urine creatinine Glucose random/fasting 057 HBAc 06 Two-hour glucose-ogtt 09 Tonometry 0 Basic capital equipped in own rooms by ophthalmologists Fundus examination Podiatrist Dietician (Ophthalmologist) 009 00 or 00 07 680 or 680 or 680 800 or 80 or 80 or 80 or 80 or 805 (Other Specialist) Page 6 of 05/08
Condition Diagnostic Ongoing management Diabetes type ECG Electrocardiogram or or 6 Microalbuminuria 6 or 6 description ECG Electrocardiogram or or 6 Microalbuminuria 6 or 6 follow-up s each Urine analysis (dipstick) 88 Urine analysis (dipstick) 88 Total cholesterol 07 Total cholesterol 07 LDL cholesterol 06 LDL cholesterol 06 HDL cholesterol 08 HDL cholesterol 08 Triglycerides 7 Triglycerides 7 U & E only 7 U & E only 7 Serum creatinine Serum creatinine Urine creatinine Urine creatinine Glucose random/fasting 057 HBAc 06 Two-hour glucose- OGTT 09 Tonometry 0 Dysrhythmia ECG Electrocardiogram or or or 5 or 6 Echocardiography 6 & 6 & 6 & 60 & 65 Basic capital equipped in own rooms by ophthalmologists Fundus examination Podiatrist Dietician (Ophthalmologist) 009 00 or 00 or 07 680 or 680 or 680 800 or 80 or 80 or 80 or 80 or 805 (Other Specialist) ECG Electrocardiogram or or or 5 or 6 Echocardiography 6 & 6 & 6 & 60 & 65 U & E only 7 U & E only 7 Magnesium: Spectrophotometric 09 Magnesium: Spectrophotometric or or 09 C-reactive protein 97 Prothrombin index (PI) 805 Page 7 of 05/08
Condition Diagnostic Ongoing management description Dysrhythmia Thyrotropin (TSH) 507 Therapeutic drug level: Dosage Hour ambulatory ECG monitoring (holter) Serum calcium Epilepsy EEG Electro-encephalography 8 & 9 06 or 07 or 75 or 76 7 & 7 Drug level in biological EEG Electro-encephalography EEG with special activation 75 Drug level in biological follow-up s each 806 08 or 70 or 9 7 & 7 08 or 70 or 9 Page 8 of 05/08 Glaucoma Tonometry 0 Tonometry 0 Haemophilia Fundus examination 00 or 00 Fundus examination 00 or 00 Gonioscopy 00 Gonioscopy 00 Basic capital equipped in own rooms by ophthalmologists Visual fields Disc and nerve fibre layer analysis or Disc photography Optical Coherent Tomography (OCT) of Optic nerve or macula Central corneal thickness measurement Factor VIII or Factor IX antigen or Coagulation factors 009 Basic capital equipped in own rooms by ophthalmologists 06 or 07 06 or 07 08 ( per eye) 00 ( per eye) 758 or 757 Visual fields 06 or 07 Disc and nerve fibre layer analysis or Disc photography Optical Coherent Tomography (OCT) of Optic nerve or macula Retinal threshold trend evaluation Factor VIII or Factor IX inhibitors 009 06 or 07 08 ( per eye) 08 7 Full blood count 755 Full blood count 755 Platelet count 797 Platelet count 797 Fibrinogen titre 85 PTT - Partial thromboplastin time 87 Prothrombin index (PI) 805 Therapeutic drug level: Dosage 806 Bleeding time 7 Thrombin time 8 Hyperlipidaemia Total cholesterol 07 Total cholesterol 07 0 LDL cholesterol 06 LDL cholesterol 06 HDL cholesterol 08 HDL cholesterol 08 Triglycerides 7 Triglycerides 7 Thyrotropin (TSH) 507 AST Aspartate 0
Condition Diagnostic Ongoing management Hyperlipidaemia Hypertension ECG Electrocardiogram or description ALT Alanine ECG Electrocardiogram or follow-up s each Urine analysis (dipstick) 88 Urine analysis (dipstick) 88 Glucose random/fasting 057 Glucose random/fasting 057 Total cholesterol 07 Total cholesterol 07 Hour ambulatory blood pressure or U & E only 7 or 7 Potassium Hypothyroidism Thyrotropin (TSH) 507 Thyrotropin (TSH) 507 0 Multiple sclerosis Parkinson s disease Rheumatoid arthritis Free thyroxine (FT) 8 Free thyroxine (FT) 8 Total cholesterol 07 MR of the brain pre and post contrast or MR of the cervical spine and cranio-cervical junction pre and post contrast or MR of the thoracic spine pre and post contrast or MR of the lumbar spine pre and post contrast or Visual evoked potentials (VEP): Unilateral Visual evoked potentials (VEP): Bilateral 00 or 00 50 or 50 or 500 50 or 50 or 500 50 or 50 or 500 MR of the brain pre and post contrast or MR of the cervical spine and cranio-cervical junction pre and post contrast or MR of the thoracic spine pre and post contrast or MR of the lumbar spine pre and post contrast or 68 AST Aspartate 68 ALT Alanine 00 or 00 50 or 50 or 500 50 or 50 or 500 50 or 50 or 500 0 No diagnostic or monitoring s apply as the diagnosis of this condition remains a clinical one Erythrocyte sedimentation rate or C-reactive protein 7 or 97 Erythrocyte sedimentation rate or C-reactive protein 7 or 97 Full blood count 755 Full blood count 755 Platelet count 797 Platelet count 797 Urine analysis (dipstick) 88 Urine analysis (dipstick) 88 AST Aspartate ALT Alanine 0 AST Aspartate ALT Alanine 0 Anti-CCP 600 Anti-CCP 600 X-ray of the right hand 6505 X-ray of the right hand 6505 X-ray of the left hand 6500 X-ray of the left hand 6500 X-ray of the right foot 75 X-ray of the right foot 75 Page 9 of 05/08
Condition Diagnostic Ongoing management Rheumatoid arthritis Schizophrenia Systemic lupus erythematosus description follow-up s each X-ray of the left foot 70 X-ray of the left foot 70 Rheumatoid factor 959 ANF 9 00 AST Aspartate ALT Alanine 00 0 U & E only 7 Drug level in biological or 08 or 70 or 9 Full blood count 755 Full blood count 755 Urine analysis (dipstick) 88 Urine analysis (dipstick) 88 U & E only 7 U & E only 7 Platelet count 797 Platelet count 797 Complement fixation Erythrocyte sedimentation rate or C-reactive protein Skin biopsy 00 96 or 8 7 or 97 or 567 & 0 & 0 & 05 & 07 Complement fixation 96 or 8 Erythrocyte sedimentation rate or C-reactive protein 00 7 or 97 or Total cholesterol 07 Kidney biopsy 8 kinase 5 or 5 Extractable nuclear antigens 9 or 98 Urine microscopy 867 AST Aspartate ANF 9 ALT Alanine DNA antibodies 59 or 98 Histology 567 & 57 or 58 & 58 Antiglobulin (Coombs) 709 0 Page 0 of 05/08
Condition Diagnostic Ongoing management Ulcerative colitis Colonoscopy 65 or 656 description Colonoscopy 65 or 656 follow-up s each C-reactive protein 97 C-reactive protein 97 Full blood count 755 Full blood count 755 Histology 567 & 57 or 58 & 58 Histology 567 & 57 or 58 & 58 Flexible sigmoidoscopy 676 Complaints process You may lodge a complaint or query with Glencore Medical Scheme directly on 0860 00 or address a complaint in writing to the Principal Officer at the Scheme s registered address. Should your complaint remain unresolved, you may lodge a formal dispute by following the Glencore Medical Scheme internal disputes process. You may, as a last resort, approach the Council for Medical Schemes for assistance.council for Medical Schemes Complaints Unit, Block A, Eco Glades Office Park, 0 Witch-Hazel Avenue, Eco Park, Centurion, 057 / 086 67 / complaints@medicalschemes.com/ www.medicalschemes.com Page of 05/08