Prescribed Minimum Benefits (PMBs) are a set of predefined conditions that form part of South Africa’s Medical Schemes Act. With PMBs, anyone who is part of a medical scheme, no matter what medical aid plan they’re on, can receive treatment for 270 hospital-based and 25 chronic conditions, and the price of these will be covered in full. The aim of PMB cover is to ensure that the wellbeing and health of South African medical aid members is safeguarded, and that private healthcare is more affordable. PMBs also cover any kind of emergency treatment and include certain out-of-hospital treatments.
How does a doctor decide if my condition will be covered by a PMB?
Your doctor will look purely at your symptoms to decide whether you’re covered under a PMB. In other words, they won’t look at how the condition was contracted in the first place, but rather the symptoms you are displaying at that current point in time. They will then decide where you should receive the treatment in terms of in the doctor’s surgery or in hospital.
What kind of conditions does a PMB cover?
You can read the full list of hospital-based PMB conditions covered, which are grouped into 15 broad categories and include things like heart attacks, strokes and pneumonia. The 25 chronic diseases in the PMBs include conditions like epilepsy and bipolar mood disorder – read the full list.
Where can I get help with a PMB related issue?
The Council for Medical Schemes (CMS) was established to supervise medical schemes in South Africa and exists to protect your right as a consumer to be treated fairly. If you need help with a PMB issue, contact them for guidance.
