What are prescribed minimum benefits (PMBs)?
The benefits in respect of relevant health services prescribed by the regulations under the Act, and rendered by state hospitals or designated service providers according to clinical protocols and criteria. No restrictions, co-payments, waiting periods or exclusions may be applied to any person in respect of the prescribed minimum benefits if the services are rendered by state hospitals or DSPs.There are 270 conditions classified as PMBs, and 25 chronic conditions. All schemes must provide treatment for these conditions.
In instances where services are voluntarily obtained from a non-DSP, co-payments may apply or waiting periods may be imposed only on those applicants who have never belonged to a medical scheme, or have not been beneficiaries for the preceding 90 days.
Susan Erasmus is a freelance writer for Health24.