The code of conduct for prescribed minimum benefits for medical schemes has been released, the Council for Medical Schemes said on Tuesday.
The code was an attempt to achieve full compliance with the PMB regulations prescribed in the Medical Schemes Act (Act 131 of 1998), it said in a statement.
PMBs are a set of defined benefits to ensure all medical scheme members have access to certain minimum health services, regardless of their benefit option.The code would give guidance on entitlements prescribed in PMB regulations and the prescribed level of care for PMB conditions. It would also provide information on identifying PMB conditions and administrative processes such as pre-registration, pre-authorisation and dealing with disputes. (Sapa – 4 August 2010)