Discovery Health PMB Form

The purpose of the Discovery Health PMB Form PDF is to apply for out-of-hospital treatment funding for a Prescribed Minimum Benefit (PMB) condition from a South African medical scheme. The form, formally titled the Application for Out-of-Hospital Treatment of a Prescribed Minimum Benefit Condition, is used by patients and their healthcare professionals to request cover for consultations, procedures, medicine, radiology and pathology. PMBs are conditions for which medical schemes must provide cover as mandated by the Medical Schemes Act.

Who uses the Discovery Health PMB Form PDF?

You use this form as a General Practitioner or other healthcare professional in South Africa, completing it with your patient. The patient fills out their personal details and provides consent. You complete the clinical sections, including the date of diagnosis, treatment plan details and a motivation for the requested cover. For psychotherapy applications, you must submit the application through a specific online portal. If you are a referring specialist, you also provide your details on the form.

What is included in a Discovery Health PMB Form PDF?

A Discovery Health PMB Form PDF includes patient details, the clinical application for treatment, a motivation for additional cover and referring professional information.

• Patient personal details, medical scheme information and consent declarations
• Nomination of a primary care GP
• Date of diagnosis for the PMB condition
• Out-of-hospital treatment plan with ICD-10 and professional billing codes
• Medicine application with medication name, strength and dosage
• Radiology and pathology requests with relevant procedure codes
• Specific requirements for psychotherapy, including an indicator for internet-based CBT
• A free-text clinical motivation explaining why additional cover is needed
• Referring healthcare professional's details and signature

Common Problems of Completing Discovery Health PMB Form PDFs

Treatment Plans Require Specific Billing Codes

The form requires you to provide professional billing codes for every requested consultation, procedure, radiology and pathology item. Simply describing the clinical service is not enough. This means you must be familiar with the correct billing code system to ensure the application is processed correctly. Claims submitted without the appropriate ICD-10 and procedure codes may not be paid from the correct benefit, leading to delays and administrative rework for your practice.

The Motivation Section Is Time-Consuming to Write

Section 3 of the form requires a free-text motivation explaining why additional cover is needed beyond the standard treatment basket. For patients with complex conditions, writing a persuasive clinical rationale can be time-consuming. You need to summarize the patient's situation, treatment history and the specific reasons for the request, which is a significant documentation task on top of a busy clinic day. An insufficient motivation can result in the application being rejected.

Psychotherapy Applications Have a Separate Pathway

If the application is for psychotherapy, you cannot use the standard paper form. Instead, you must submit the request via a specific online health platform. This creates a dual submission system that can be confusing to navigate. For children under 13, the process has another layer of complexity, requiring a specific diagnostic form with a GAF score. Managing these different pathways adds administrative overhead and potential for error when coordinating care.

Benefits of Using Heidi to Auto-Fill Discovery Health PMB Form PDFs

Your Treatment Plan, Populated With the Right Codes

You discuss the treatment plan with your patient, including procedures, investigations and medications. Heidi listens and generates the detailed tables for Section 2 of the form. It pulls consultations and procedures with their ICD-10 codes from the visit note, matches them to professional billing codes, and extracts medications and ordered investigations from the patient's record. This gives you a complete draft as a starting point for your review.

A Clinical Motivation Drafted From the Patient's Story

Writing a compelling motivation for additional cover can be challenging. Based on the visit and the patient’s history, Heidi drafts the clinical motivation for Section 3. It summarizes the condition's severity, treatment history and the clinical rationale for needing cover beyond the standard basket, using information from your visit notes and available investigation results. You review and edit the draft to ensure it accurately reflects your clinical judgment.

Your Admin Details, Filled In Automatically

Finding practice numbers and contact details while filling out forms is a frustrating use of time. Heidi pre-populates the form with the necessary administrative information. It pulls the patient’s demographic and membership details for Section 1 and your name, practice number, specialty and contact information for Section 4 from existing records. This saves you from repetitive data entry and lets you focus on the clinical parts of the application.