What are Prescribed Minimum Benefits (PMBs)

To protect medical scheme members, the law determines the minimum benefits that a medical benefit fund must offer their members. These are called the Prescribed Minimum Benefits (PMBs). 

According to the Medical Schemes Act (131 of 1998) and its Regulations, all medical schemes have to cover the costs related to the diagnosis, treatment and care of:  

  • Any life-threatening emergency medical condition 
  • A defined list of 270 medical conditions
  • A defined list of 27 chronic conditions (Chronic Disease List (CDL) conditions). 

You can find out which conditions form part of the CDL conditions, the list of 270 conditions and their treatment pairs as well as what the definition of an emergency medical condition is on the Council for Medical Schemes’ website at www.medicalschemes.com 

More information about PMBs and how to apply:

Guide to Prescribed Minimum Benefits

Application for out-of-hospital management of a Prescribed Minimum Benefit condition

Application for  additional-out-of-hospital management of a Prescribed Minimum Benefit condition

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