PMB is an acronym for Prescribed Minimum Benefits as stipulated by the Council for Medical Schemes.
PMBs are defined by law and deal with the minimum level of diagnosis, treatment and care that your Medical Aid scheme must cover. Your Medical Aid Scheme must pay for these conditions or treatments from its risk pool, (so not from your savings for instance), and it must pay for it in full.
But, be aware! The law also makes provision for Designated Service Providers, Managed Care Protocols and Formularies.
What this means for you as a Medical Aid member is that as long as you follow the rules of your Medical Aid Scheme and use their Designated Service Providers they are bound by law to pay PMB claims in full. Should you however decide not to follow their rules, or use a doctor, specialist or other service provider that is not on the Designated Service Provider list of your scheme, you may be liable for excesses or co-payments as specified by your Medical Aid policy.
Do not assume these excesses or co-payments will be covered by your Gap Cover. Click here to read how you can make sure you are covered.
Medical Aid Schemes make use of Designated Service Providers, Managed Care Protocols and Formularies to manage their costs in providing for PMB claims and in doing so enabling them to offer cheaper premiums.