Prescribed Minimum Benefits (PMB)

The Prescribed Minimum Benefits or PMB’s is a list of diseases or conditions listed in the Medical Schemes Act which schemes are required to pay for. Included in this is the Chronic Disease List (CDL list) of chronic conditions that also fall under the umbrella of PMB’s.

In certain circumstances the Scheme may only provide cover for members and their dependants in provincial hospitals or at the Scheme’s appointed private Designated Service Provider (DSP) facilities. All PMB conditions will be funded according to Scheme rules and protocols at the appropriate level of care.

Benefits will be restricted to PMB cover in the following circumstances:

• Where a member or their dependant/s, who could reasonably have obtained a service from a preferred provider, chooses to use another provider of his/her choice, the Scheme’s liability for the costs of obtaining such services will be restricted

• Members with waiting periods imposed upon joining the Scheme may or may not have cover for PMB conditions

• Members should check this on their Terms of Acceptance letter

• Where a PMB condition requires further treatment but annual benefits have been exhausted

• Where benefits are limited to PMB

Note: Where specific benefits are limited to PMB conditions, members may be liable for a co-payment if services are obtained from a non- DSP facility.

List of chronic diseases:

• Addison’s Disease (PMB)
• Anaemia
• Angina Pectoris791 7987
• Ankylosing Spondylitis
• Asthma (PMB)
• Benign Prostatic Hypertrophy
• Bronchiectasis (PMB)
• Cardiac Dysrhythmia (PMB)
• Cardiac Failure (PMB)
• Cardiomyopathy (PMB)
• Chronic Obstructive Pulmonary Disease (COPD) (PMB)
• Chronic Renal Failure/ Disease (PMB)
• Crohn’s Disease (PMB)
• Cushing’s Syndrome
• Depression
• Delusional Disorder
• Diabetes Mellitus Type 1 & 2 (PMB)
• Emphysema
• Epilepsy (PMB)
• Female Menopause
• Glaucoma (PMB)
• Gout
• Haemophilia (PMB)
• Hyperlipidaemia (PMB)
• Hypertension (PMB)
• Hyperthyroidism
• Hypothyroidism (PMB)
• Idiopathic Thrombocytopenic Purpura
• Incontinence
• Interstitial Fibrosis of the Lung
• Ischaemic Heart Disease (Coronary Artery Disease)(PMB)
• Meniere’s Syndrome
• Motor Neuron Disease
• Myasthenia Gravis
• Osteoporosis
• Paget’s Disease
• Parkinson’s Disease (PMB)
• Peripheral Vascular Disease
• Pituitary Adenoma
• Psoriasis
• Reflux Oesophagitis
• Rheumatoid Arthritis (PMB)
• Scleroderma
• Stroke
• Systemic Lupus Erythematosus (PMB)
• Ulcerative Colitis (PMB)