Prescribed Minimum Benefits

What are Prescribed Minimum Benefits?

Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.

PMBs are a feature of the Medical Schemes Act, in terms of which medical schemes must cover the costs related to the diagnosis, treatment and care of:

  • any emergency medical condition;
  • a limited set of 271 medical conditions (defined in the Diagnosis Treatment Pairs); and
  • 26 chronic conditions (defined in the Chronic Disease List).

When deciding whether a condition is a PMB, the doctor should only look at the symptoms and not at any other factors, such as how the injury or condition was contracted. This approach is called diagnosis based. Once the diagnosis has been made, the appropriate treatment and care is decided upon as well as where the patient should receive the treatment (at a hospital, as an outpatient or at a doctor’s rooms).

2022 – PMB ICD-10 Coded List

2022 – CMS PMB ICD-10 Coded List – CHANGES

Note: The Council for Medical Schemes (CMS) would like to bring to your attention the publication of the new PMB Coded List. Clinical Review Committee members have established that the 2013 PMB and ICD-10 Coded List needs to be updated to include previously omitted ICD-10 codes and COVID-19. The changes are implemented with immediate effect. Please see the updated PMB Coded List ABOVE, along with a summary of changes made to the list.

PMB’s Emergencies Explained

Medical Aid Benefits Cannot Run Out

Chronic Disease List (CDL)

270 PMB’s

Prescribed Minimum Benefits Raise Costs

PMB Condition – Chronic Lymphocytic Leukemia

PMB Condition – COPD

PMB Condition – The Thyroid

PMB Condition – Crohn’s Disease & Ulcerative Colitis

PMB Condition – Exposure to the Elements_Part 1

PMB Condition – Exposure to the Elements_Part 2

PMB Condition – HIV

PMB Condition – Prostate Cancer

PMB Condition – Tuberculosis

PMB Condition – Malaria

PMB Condition – Breast Cancer

PMB – Conditions & Illnesses queried most often

PMB Condition – Dystonia Syndrome

ST-segment elevation myocardial infarction

Unstable Angina-Non-ST segment elevation myocardial infarction

PMB Condition – Brain Tumours