Understanding your PMB
Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected on their medical aid.
Libcare has to cover the minimum health services related to the diagnosis, treatment and care of:
- any emergency medical condition, as defined;
- a limited set of 271 medical conditions (defined in the 'Diagnosis Treatment Pairs' in legislation);
- and 26 chronic conditions (defined in the Chronic Disease List).
Each of the 271 PMB conditions is linked to a broadly-defined treatment protocol referred to as Diagnosis Treatment Pairs (DTPs). The treatment standards in question are the public sector practice and protocols.
In the case of the chronic diseases specified in the Chronic Disease List (CDL), the treatment algorithms that have been published in the Government Gazette are the minimum treatment requirement.
For more details on PMBs please visit our website www.libcare.co.za > Benefit Guide or see the Council for Medical Schemes (CMS) website www.medicalschemes.co.za.