Prescribed Minimum Benefits (PMB)

The Council for Medical Schemes (CMS) introduced Prescribed Minimum Benefits (PMBs) into the Medical Schemes Act to ensure that members of medical schemes would not run out of benefits for certain conditions as this would cause them to pay for medical treatment and services out of pocket. These PMBs cover a wide range of conditions, such as meningitis, various cancers, menopausal management, cardiac treatment, medical emergencies and more.

Everything you need to know about PMBs:

Every medical scheme in the country, including Wooltru Healthcare Fund, is required to provide cover to its members for medical services related to the management of a specified number of PMB health conditions defined in the Medical Schemes Act.

The cover includes costs relating to the diagnosis and treatment of:

• The 26 listed common chronic health conditions on the Chronic Disease List (CDL).
• 270 other listed health conditions known as the Diagnosis and Treatment Pairs (DTPs).
• An emergency medication condition that results in hospitalisation. If you go to an emergency centre and the doctor does not admit you to hospital, the costs of the treatment will come out of your AML.

Where the diagnosis and treatment was obtained from a Designated Service Provider (DSP), the Fund will cover the cost thereof in full, without you having to make a co-payment.