Tag: Prescribed Minimum Benefit (PMB)

While the President has signed the National Health Insurance (NHI) into law, the bean counters at National Treasury have yet to start looking for their excel sheets needed to ensure the NHI is fully costed. The first reason is due to the confusion of objective versus political ideology. The NHI has been touted as introducing “universal healthcare coverage” (UHC).

Affordability is a prime concern for many when it comes to choosing the right medical aid plan. Medical inflation consistently outpaces general inflation, so year after year employees need to balance coverage and cost.

There is a lot of confusion and misunderstanding when it comes to medical aid versus medical insurance, and where hospital plans fit in, and this can make it difficult to decide what the best solution is to meet your needs. The reality is that they are not the same, and you cannot actually compare them, as they offer completely different benefits and serve different purposes.

South Africa's healthcare system has experienced significant transformations over the years. One of the most pressing issues is the need for more resources and funding, which has resulted in limited access to healthcare services for South Africans.

In the case of Keyhealth Medical Scheme v the Honourable Mr Justice SM Ngoepe N.O, the Registrar of Medical Schemes and William Reed, Case Number: A203/2021, a full bench of the Pretoria High Court held that prescribed minimum benefits (PMBs) must not be paid from a member's personal medical savings but must be paid from the medical scheme's PMB risk pool. 

If you are a medical scheme member, you have probably heard the phrase Prescribed Minimum Benefits or PMBs. But precisely what are they, who are they for, and when do they get used? It might help to answer some of your questions and concerns and help you to understand what you are entitled to and how PMBs fit into your medical aid cover.

Access to quality primary health care will address around 90% of our population’s health needs throughout their lives, largely through early detection and prevention of disease, preventative care and health screenings including vaccinations, cancer screenings, pre-natal and antenatal care, as well as ongoing management of chronic conditions, building a more resilient, healthier, productive population.

Many South African’s feel the economic impact of the pandemic, which has ultimately affected their pocket. People are forced to make difficult decisions in order to rearrange their finances to suit their current financial constraints. 

Medical aid rates have increased above inflation for a number of years. In addition, food prices have also increased by at least 10%, fuel prices are volatile, and salary increases are typically lower than inflation. The cost of living is higher than ever, and there is little relief in the form of tax credits and rebates.

Pursuant to a circular published by the Council of Medical Schemes (CMS) on 26 March 2020 (the Circular), declaring COVID-19 a prescribed minimum benefit, as that term is defined in the Medical Schemes Act No. 131 of 1998 (MSA), the Minister of the Health has amended the MSA to align with the Circular.