Prescribed Minimum Benefits (PMB’s)

Here is an article from our March 2004 Journal archives. The article deals with Prescribed Minimum Benefits in the early years of its introduction within the medical aid industry.

In order to prevent medical schemes from applying ‘carte blanche’ exclusionsfor pre-existing conditions and thereby placing immediate financial burdens directly on the member (or as a knock-on effect, on the state facilities themselves), medical schemes were obliged to pay for diagnostics, surgery or treatment over a range of 270+ conditions. The member has to utilise the designated hospital network of the scheme, and the network often consisted of state facilities themselves.

The main advantage to the member under this system is that if the member voluntarily transfers membership to another scheme and possibly, as a result, subjects him/herself to waiting periods in respect of general cover and private hospital benefits, they at least have the advantage of PMB cover within the state network.

In addition to the 270 diagnostics above, from January 2004, a total of 25 chronic conditions were included in the Regulations dealing with PMB’s and mainly covering a range of medications.

These 25 conditions have to be included as part of the benefits covered by all schemes over all their different registered options. The conditions covered include Hypertension, Diabetes, Asthma, Cardiac failure, Glaucoma, Hypothyroidism, Multiple Sclerosis, and Epilepsy.

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