Prescribed Minimum Benefit (PMB)
By law all medical schemes in South Africa must cover a minimum set of medical treatments for certain conditions. This is even true when scheme exclusions apply or when we have applied waiting periods in certain circumstances, or when you have reached a limit for an applicable benefit.
The PMB is a package of minimum clinical benefits that Remedi must pay for. Your available Personal Medical Savings Account (if you are on the Comprehensive option) cannot be used to pay for these benefits.
The PMB consists of a list of medicine and treatments for specific chronic conditions and HIV or AIDS treatment and cover for certain diagnosis-based procedures.
We may only pay for PMBs if treatment is provided by or at one of Remedi’s DSPs, except in emergencies, unless otherwise indicated.
It is important to note that even if your doctor says it is a PMB, only the condition ICD-10 codes that your doctor submits, and the rules will determine whether it is covered or not.