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Medical Aid and PMBs: everything you need to know!

As a premium paying medical aid member, it is crucial that you have a clear understanding of the way that prescribed minimum benefits (PMBs) work, as they are a secure way for you to get high-level treatment in and out of hospital cost without having to pay extra out...
Medical Claims

“PMB only” cancer treatment: what does this mean?

An increasing number of medical aids cover "PMB only" for cancer benefits. It is not always clear to members what that means, and they are often surprised that their cover is not as robust as they thought it was. According to the Medical Schemes Council, PMBs are a feature of...

PMBs and Mental Conditions: what does medical aid cover?

PMB Mental Health conditions These PMB mental conditions must be covered by medical aids without charging the member out-of-pocket expenses, assuming that protocols and DSPs (Designated Service Providers) are followed. CODE CONDITION TREATMENT 182T Abuse or dependence on Psychoactive substance, including alcohol Hospital-based management up to 3 weeks/year 910T Acute delusional mood, anxiety, personality, perception disorders and organic...

List of the 27 CDL (PMB) Chronic conditions

Chronic PMB conditions PMB (Prescribed Minimum Benefits), including chronic PMB conditions, are conditions that any medical aid needs to pay for, regardless of what plan you are on. No savings should be used to pay for this treatment, and there should be no co-payments. This is the set of chronic conditions...

How are medical aids supposed to pay for PMBs?

PMBs are 270 conditions that schemes have to cover without requiring co-payments or savings from you, even if the treatment is provided out-of-hospital. This applies to every plan.
Managed Programs

List of PMB conditions and their prescribed treatment

Below is a list of the Categories (Diagnosis and Treatment Pairs) constituting the Prescribed Minimum Benefits (PMB) Package under Section 29(1)(o) of the Medical Schemes Act (listed by Organ-System chapter). IMPORTANT: For an explanation of general treatments (example: "Medical Management") please click here NOS means "not otherwise specified". BRAIN AND NERVOUS SYSTEM CODE CONDITION TREATMENT For...

Discovery Chronic Condition coverage

Full list of all the chronic conditions covered by each of the Discovery Health plans, including information about PMBs and medicine formularies

All the jargon explained

Don't be put off by the medical aid jargon that you find on this site, and on the medical aid marketing brochures. There are key terms that it is absolutely essential that you understand, and we explain those below. DSP A Designated Service Provider (DSP) is a healthcare provider (doctor, pharmacist,...

Medical Aid FAQs