WHAT ARE PRESCRIBED MINIMUM BENEFITS? 

Prescribed Minimum Benefits, also known as PMBs, are a list of diseases or conditions that a medical scheme is required to fund. A detailed list can be found on the Council for Medical Schemes’ website (www.medicalschemes.com).

FUNDING OF YOUR PMB CONDITION

Your PMB cover will be funded from your option’s existing benefits first. Thereafter, your condition will be funded by the Scheme’s risk pool and we’ll require the following for you to enjoy extended cover from your treating provider:

  • Confirmation of the clinical condition 
  • Relevant ICD10 code
  • Supporting documentation
  • Motivation from your doctor
  • Applicable medical reports
  • Any additional information requested by the Scheme

STRETCHING YOUR PMB COVER

The first thing you should do after being diagnosed is to get in touch with your Personal Health Coordinator to discuss your disease-specific care path.

You can also substantially stretch your PMB benefits by making use of a hospital, doctor, specialist or any other healthcare professional that the Scheme has an agreement with. However, in a life threatening situation, you may go to any hospital, doctor or specialist but, as soon as you are able to access one of our network providers, you must do so to continue enjoying full cover for your condition. 

 

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