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 271 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 271 PMB conditions, 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.
Members 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 you get cover from the correct benefit.
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
Value Care Plan members are entitled to full cover for medicine prescribed by a Prime Cure healthcare practitioner, according to Prime Cure formulary (medicine list), for the treatment of these 26 conditions.