Can a lack of knowledge regarding Prescribed Minimum Benefits (PMBs) mean that you, instead of your medical scheme, end up paying for the treatment of conditions, diagnosis and care?

PMBs: Final Episode

		In this last episode...
		Suzie Q makes a desicion regarding her Medical Aid

After all Suzie’s research and questioning of friends and family the choice of Medical Aid seemed a lot less complex than it did when she started her quest. ‘Prescribed Minimum Benefits’ made all the difference! Suzie summed up her findings about ‘Prescribed Minimum Benefits’ as follows:

• It is a set of defined benefits, to ensure that all medical aid members are provided with a certain minimum health benefits, irrespective of the benefit option they have selected
• It is a feature of the Medical Schemes Act which means Medical Aid companies have to cover costs related to the diagnosis, treatment and care of:
  • Any emergency medical condition
  • A limited set of 271 medical conditions
  • And 26 chronic conditions defined in the Chronic Disease List.
• It ensures that Medical Aid companies must pay in full, without co-payment or the use of deductibles for the diagnosis, treatment and care costs of the Prescribed Minimum Benefits conditions
• It means that Medical Aid companies cannot use your medical savings account or day to day benefit to pay for Prescribed Minimum Benefits
• It also means that each option provided by any medical aid company must provide for Prescribed Minimum Benefits including hospital plans

For Suzie it was now a case of choosing a reputable medical aid company with great coverage and extras and for this she sought out the advice of her medical aid broker. Suzie couldn’t believe how worried she had been when Clarence, the human resources manager, first confronted her with the question of which medical aid she would sign up to. With a good understanding of Prescribed Minimum Benefits it would be so much easier for almost anyone to choose a medical aid. Suzie informed Clarence of her choice and is happy and confident that her medical aid will do what it needs if and when the need arose.

Suzie had to smile at herself a few weeks later when she realised, at a lunch with some colleagues and friends, that she was the one handing out advice to everyone about Prescribed Minimum Benefits. Suzie told them what she tells anyone willing to listen “Go and read up about Prescribed Minimum Benefits, it makes all the difference. I can give you the documents or you can just go to the website www.medicalaid.co.za where they have all the information you could possibly ask for.”