Prescribed Minimum Benefits
By law all medical schemes in South Africa must cover a minimum set of medical treatments for certain conditions. This is even when Scheme exclusions apply or we’ve applied waiting periods in certain circumstances, or when you’ve reached the limit for a benefit. The Prescribed Minimum Benefits is a package of minimum clinical benefits that the medical scheme must pay for. The money in your Medical Savings Account cannot be used to pay for these benefits.
The Prescribed Minimum Benefits consist of a list of emergency admissions, diagnosis, treatment and care for 270 listed conditions, medicine and treatments for specific chronic conditions and HIV or AIDS treatment.
We’ll pay for Prescribed Minimum Benefits only if you get treatment from or at one of the Scheme’s designated service providers, except in emergencies.
