“PMB-only” organ transplants
Some medical aid plans only cover organ transplants as a “PMB-only” benefit. PMBs are “Prescribed Minimum Benefits”, and they determine what minimum level of cover your medical aid scheme must provide for over 270+ conditions. You can read more about PMBs here.
A “PMB-only” benefit means that the medical aid will provide the minimum level of care that is required by law. These include solid organ transplants (liver, kidney and heart) only where these are provided by State hospitals in accordance with Public sector protocols and subject to public sector waiting lists.
In other words, the medical aid can deny certain organ transplants or compel you to have them done in a State hospital.
Note! Medical schemes can compel you to use State facilities for the treatment of some PMBs, including organ transplants. These restrictions are usually stated in the benefit brochure for your plan. If you are not sure what your plan requires, you can find your medical aid plan and benefits here, and confirm with your scheme or broker.
How does your plan pay for organ transplants?
You can see how your plan covers organ transplants by viewing the “in-hospital” benefit for your plan. You can find this by selecting your scheme on this page, and then finding your plan. We only list open medical aid schemes at this stage.
