SchemeBookUnderstand the system. Know what to ask.
by RiskAtlas
The government-set minimum treatment standard for a CDL condition.
For each Chronic Disease List condition, a Diagnosis Treatment Pair sets out the diagnosis and the minimum standard of treatment a scheme must fund at PMB level — so 'PMB cover for diabetes' has a specific, checkable meaning rather than being left to the scheme's discretion.
More jargon
Open scheme · Restricted scheme · PMB (Prescribed Minimum Benefits) · CDL (Chronic Disease List) · Co-payment · Designated Service Provider (DSP) · Waiting period · Late-joiner penalty · Savings account / above-threshold benefit · Medical scheme · Medical aid · Medical insurance · Benefit option · Principal member · Dependant · Contribution · Underwriting · Condition-specific waiting period · Emergency medical condition · Medical savings account · Self-payment gap · Benefit limit · Scheme tariff or rate · Out-of-pocket payment · Provider network · Formulary · Generic medicine · Clinical protocol · Pre-authorisation · Managed care · Claim statement · Tariff shortfall · Claim rejection · Clinical motivation · Internal appeal · CMS complaint · Registered scheme rules