If you’re managing a chronic condition, you may not realise that you could be eligible for full coverage for your treatment through your medical aid’s Prescribed Minimum Benefits (PMBs). All medical schemes in South Africa must cover a specific list of conditions, known as PMBs, including chronic conditions like diabetes, asthma, hypertension, and more.
What are PMBs?
PMBs are conditions that every medical aid must cover in full, according to the Medical Schemes Act. This includes:
• Diagnosis
• Treatment
• Ongoing management
To ensure you’re getting the care you need under PMBs, the first step is registering your condition with your medical aid.
Step-by-Step Guide to Registering for PMBs
1. Visit Your Doctor
Your GP or specialist will need to confirm your diagnosis for a chronic condition. This is an essential step before registering with your medical aid.
2. Submit the Chronic Illness Benefit (CIB) Form
Ask your doctor to complete and submit the CIB form to your medical aid. This form will include the diagnosis, ICD-10 code, and treatment plan for your condition.
3. Wait for Approval
Once your medical aid receives your form, they’ll review it and confirm your registration. After approval, you’ll be eligible for full PMB cover for your chronic condition.
4. Start Accessing Your Benefits
Once approved, you’ll gain access to a range of services, including medications, tests, and doctor visits. These benefits will come from your hospital or chronic illness benefits, not from your savings or day-to-day funds.
Tip: If your condition is not registered, you’ll be responsible for covering the costs yourself — so get registered as soon as possible!
Why Registering PMBs Matters
By registering for PMBs, you unlock crucial benefits that could save you hundreds of rand each year on medications, specialist visits, and tests. It’s important to ensure your condition is fully registered to access these benefits.
📞 What to Do Now:
• Check if your condition qualifies for PMB coverage.
• Call your medical aid to confirm if you’re registered for PMBs and ask them to help with the registration process if needed.
• Track the tests and treatments you’re eligible for to make sure you don’t pay for what’s already covered.
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Written in collaboration with Practice Solutions — helping healthcare providers with practice management solutions so that they can focus on patient care. To learn more about their services, visit www.medpracsol.co.za
Quick Reference Table
| Benefit Type | Covers | Do You Need To Register? |
|---|---|---|
| Preventative Benefits | Check-ups, Screenings | X No registration needed |
| PMB | Emergencies & chronic conditions | ✅ Yes – must register and follow rules |
| Chronic Benefits | Ongoing tests, meds, specialist care | ✅ Yes – register & apply through your doctor |
Written in collaboration with Practice Solutions — helping healthcare providers with practice management solutions so that they can focus on patient care. To learn more about their services, visit www.medpracsol.co.za
