Medical Schemes

List of chronic diseases
All medical schemes are obligated to provide cover for the 'diagnosis and medication' of the following conditions.

Why do we have PMBs?
The reason why PMBs were created basically comes down to two facts, medical schemes and healthcare.

Why are designated service providers important?
A Designated Service Provider is a healthcare provider that is a medical scheme’s first choice when its members need diagnosis, treatment or care for a PMB condition.

Medical scheme beneficiaries
PMBs are very good news for medical scheme beneficiaries and give them considerable rights as far as healthcare is concerned.

Which conditions are covered?
The Regulations to the Medical Schemes Act in Annexure A provide a long list of conditions identified as Prescribed Minimum Benefits.

Know your scheme's PMBs
Read your scheme's policy - and understand what constitutes a Prescribed Minimum Benefit.

What are PMBs?
PMBs are a set of defined benefits that ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected.

What are emergency conditions?
An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment and/or an operation.

The importance of ICD-10 codes
One code that appears on a healthcare provider account is ICD-10 codes. These codes are used to inform medical schemes about the conditions the members were treated for.

Questions on PMBs
FAQs and other facts about PMBs, medical schemes, healthcare providers and chronic conditions.

HIV and your medical scheme
HIV is a PMB. Medical schemes are increasingly geared towards giving people living with HIV/Aids that much-needed extra bit of support for a healthy and productive life.