Prescribed Minimum Benefits

As a member of a medical scheme, you have access to Prescribed Minimum Benefits (PMBs). PMBs are a set of defined benefits put in place to ensure all beneficiaries have access to certain minimum healthcare services, regardless of the benefit option they have selected. These 270 PMBs cover the most common conditions, ranging from fractured bones to various cancers, menopause management, cardiac treatment and medical emergencies. Some of them are life threatening conditions for which cost-effective treatment would sustain and improve the member’s quality of life.

PMB diagnosis and treatment can be received wherever it is most appropriate – in a hospital, an outpatient setting or even at home. The access to diagnosis, medical or surgical management and treatment of these conditions is not limited, and is paid according to specific protocols per condition. In addition to the 270 PMBs, you are also guaranteed treatment and medication for 26 chronic conditions. Members with these chronic conditions will need to visit their healthcare practitioner and may have to register the condition on a specialised chronic disease management programme. Some disease management programmes are obtained from a designated service provider (DSP). Once registered, members will be entitled to a treatment basket, including medication, according to treatment protocols and reference pricing.

We pay for the diagnosis, medical management and medicine for the 26 chronic conditions listed under Prescribed Minimum Benefits (PMBs) at 100% of the Scheme Reimbursement Rate, according to defined treatment plans and Scheme protocols.

PMB Chronic Conditions

  • Addison's Disease
  • Asthma
  • Bipolar Mood Disorder
  • Bronchiectasis
  • Cardiac Failure
  • Cardiomyopathy
  • Chronic Renal Disease
  • Chronic Obstructive Pulmonary Disease
  • Coronary Artery Disease
  • Crohn's Disease
  • Diabetes Insipidus
  • Diabetes Mellitus Type 1
  • Diabetes Mellitus Type 2
  • Dysrhythmias
  • Epilepsy
  • Glaucoma
  • Haemophilia
  • Hyperlipidaemia
  • Hypertension
  • Hypothyroidism
  • Multiple Sclerosis
  • Parkinson's Disease
  • Rheumatoid Arthritis
  • Schizophrenia
  • Systemic Lupus Erythematosus
  • Ulcerative Colitis

To confirm which other nonrelated PMB chronic conditions Anglo Medical Scheme covers and how we classify them, please view eligible chronic conditions here.

Registration of Prescribed Minimum Benefits chronic conditions

 

Members of the Managed Care Plan with chronic conditions need to register their conditions with the Scheme to ensure appropriate funding. Once you register, the Scheme's administrator will send you a treatment plan.

You need to ensure the diagnosis code for the registered chronic condition (known as an ICD-10 code) reflects on all accounts. This is to ensure that you get cover from the correct benefit.

The Scheme will pay for medicine for these 26 chronic conditions according to a medicine reference price list and a defined list of medication.

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