Prescribed Minimum Benefits

List of LinkMax Pharmacies

Application Forms

for Chronic Medicine for Prescribed Minimum Benefits (PMB)
vir Registrasie van Medisyne vir Voorgeskrewe Minimum Voordele (VMV)

What is Prescribed Minimum Benefits?

Benefits provided with CDL conditions:

Definition: “Diagnosis, medical management and medication, to the extent that this is provided for by way of a therapeutic algorithm for the specified condition, as provided by the Scheme”.

You have a choice:

• You could either use the benefits provided for Chronic or you could choose to have access to the benefits for CDL.
• You must make the choice for each separate condition.
• All the CDL conditions are listed under the Chronic benefit as well.

How do I get access the CDL benefits?

• You must register as a CDL patient with BESTmed
• You register per disease / sickness condition
• Evaluation is according to your level of the disease (classification)
• Evaluation determines which services will be included as benefits
• Services/ Benefits are included and specified in the Treatment Protocol

What benefits are provided for in CDL?

• Benefits provided for and included in the Treatment Protocol compiled by BESTmed per CDL condition depend on the disease as well as the level of the disease.
• May include:
  • Formulary medicine
  • Consultation(s) at GP and / or specialist
  • Certain pathology services
  • Certain radiology services

What is the difference between Chronic and CDL?

Medicine Formularies:

• Chronic – Millennium Comprehensive, Millennium Standard and Topcare have the same formulary. Bonus Plus has its own formulary. Millennium Basic has no chronic. The medicine formulary is also more extended than the CDL formulary.
• CDL – Each option has its own medicine formulary and the formularies are not as extensive as the one used for Chronic. Items on the Chronic formulary are not automatically included in the CDL formulary.

Co-payments:

• Chronic: The benefit is 85% and a 15% co-payment required.
•  CDL: The benefit is 100% of the agreed price if a medication has been prescribed that is on the formulary with no co-payment.

Other Services included in Treatment Protocol

Chronic:

Topcare – Most of these services are paid as Protocol benefits until the limit is reached and then are paid from the Savings Account.

Millennium Comprehensive – These services are paid from the Savings Account (threshold contributing), until the threshold is reached and then are paid as Above Threshold benefits.

Millennium Standard – These services are mostly paid from the Savings Account.

CDL:

All options – The approved services are paid as High Risk benefits or Scheme benefits and are not paid from the Savings Account.

How do I get access to the Chronic benefits?

• Request an application form for chronic benefits from BESTmed as well as a formulary (those medicines included in the formulary for the specific condition). You can call 086 000 2378 or log onto www.bestmed.co.za.
• Let the treating medical practitioner complete the application form(s) and submit to BESTmed with copy of the prescription as well as any other information that might be requested on the application form.
• The authorisation process takes approximately five (5) working days.
• The medication can be obtained from any pharmacy.
• Pay 15% as a co-payment on receipt of the medication.

How do I get access to he CDL benefits?

• Request application forms and questionnaires for the CDL program and the formulary medicine list for that specific CDL condition according to the option on which you are registered as a member. Formularies are condition specific as well as option specific. These differ from BESTmed’s formulary for Chronic benefits.
• Let the treating medical practitioner complete the application form(s) and submit to BESTmed with copy of the prescription as well as any other information that might be requested on the application form.
• The authorisation process takes approximately five (5) working days.
• The medication can be obtained from any pharmacy.
• Ensure that your medical practitioner includes the Diagnosis Code (ICD-10 code) on all accounts (according to services received for the registered conditions).
• When processing the account, the ICD-10 code will link directly with those services which qualify for benefits or as included in the treatment protocol.
• If an account does not indicate clearly that the services were part of treatment for the specific CDL condition as you have registered for, it will be paid according to the normal benefit structure and scheme rules.

Can I change from Chronic to CDL during the year?

• You can change between the programs only once per year.