The South African Medical Schemes Act 131 of 1998 contains regulations which stipulate that every scheme must provide for the diagnosis, treatment and care costs for a specific set of medical conditions as well as emergency medical conditions. These conditions are referred to as Prescribed Minimum Benefit conditions, or PMBs.
The nature of the current healthcare environment has highlighted the need for medical aid members to make sure they are well informed about every aspect of their scheme's benefit plans.
SAMWUMED is grateful to the majority of service providers who work hand-in-hand with the Scheme to ensure that members have access to healthcare at the Scheme Tariff, a rate that the Scheme considers a fair and equitable cost.
Service providers are encouraged to contact the Scheme to negotiate rates, as this will ensure a smooth claims settlement process.
Service providers can also assist by engaging and educating their patients about PMBs to make sure that planning for PMB care not only takes into account the patient's healthcare requirements but also the medical aid benefit plans they have access to.
Click on the links below to find out more about PMBs