What is PMB?

Modified on Mon, 5 Feb at 3:11 PM



Prescribed Minimum Benefits (PMB) is denoted by the acronym, refers to Prescribed Minimum Benefits. These are specific medical conditions outlined listed by legislation, mandating that the full cost of treatment is the responsibility of the medical aid. 


Legislation and Responsibility:  


According to legislative provisions, Prescribed Minimum Benefits require the medical aid to cover the entire cost of treatment for listed conditions, irrespective of the specific medical aid or chosen medical aid option by the client. To qualify for cost coverage, the treatment must align with precise treatment pairs specified for each condition. 


Claims Responsibility: 


Responsibility for claims related to Prescribed Minimum Benefits rests with the Medical aid, and the full cost obligation is enforced by legislative requirements. 

However, if treatment for a condition does not meet the specified criteria for PMB, the medical aid may impose their standard scheme rates. 


Sirago’s Gap Cover: 


Sirago’s Gap cover extends coverage for Prescribed Minimum Benefits when voluntary use of a non-designated service provider is opted for planned procedures. This ensures additional financial protection for individuals choosing such providers, aligning with the PMB framework. 


Should the medical scheme fail to settle the claim at cost, and repudiation confirmation is issued by Sirago, the client is entitled to access MedCare services. 

These services are designed to aid clients in disputing the short payment of the Prescribed Minimum Benefit shortfall with the Medical Scheme. 

Was this article helpful?

That’s Great!

Thank you for your feedback

Sorry! We couldn't be helpful

Thank you for your feedback

Let us know how can we improve this article!

Select at least one of the reasons
CAPTCHA verification is required.

Feedback sent

We appreciate your effort and will try to fix the article