Tag: PMBs
All about PMBs, and how schemes have to pay for them
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.
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...
How medical aids work
A brief introduction to how medical aids work, the different types of plans, and their obligation to cover out-of-hospital expenses for certain conditions, regardless of plan type.
Blog Posts
Pregnancy cover if you don’t have medical aid
Pregnancy is considered a medical condition, and as such is subject to waiting periods when you join/change medical aid schemes.
Waiting Periods
If you have not had medical aid for more than 90 days and are pregnant, a scheme can impose a 12 month waiting period on your pregnancy, meaning that...
Help us crowdsource information about the Late Joiner Penalty
The Medical Aid Bible team has been listening to some of our wonderful site users, and we have heard horror stories about how some of you are being overcharged for the Late Joiner Penalty. This enticed us to investigate how each scheme handles the penalty. We found some big irregularities.
Our complaint against Bestmed re late joiner penalty
We investigated all the open medical schemes, and discovered some discrepancies in how some schemes are representing the late joiner penalties (LJP). Bestmed was one of those schemes.
Our complaint against Commed re late joiner penalty
We investigated all the open medical schemes, and discovered some discrepancies in how some schemes are representing the late joiner penalties (LJP). Commed was one of those schemes.
Our complaint against Genesis re late joiner penalty
We investigated all the open medical schemes, and discovered some discrepancies in how some schemes are representing the late joiner penalties (LJP). Genesis was one of those schemes.
Is your late joiner penalty worked out correctly?
We have found that some schemes and brokers misrepresent or miscalculate how the late joiner penalty is applied. We have laid three complaints with the Council of Medical Schemes. If you are paying a late joiner penalty, you can use the information on this page to determine if you are paying the correct penalty.
Should a medical aid scheme pay for experimental treatment?
Should medical schemes fund experimental treatments if they are a member's only option for survival?