CMS PMB conditions
The Council for Medical Schemes describes a limited set of 271 medical conditions defined through Diagnosis Treatment Pairs.
South African medical schemes, clearly explained
Understand the system.
Know what to ask.
71 registered schemes8 detailed guides38 explained termsDirectory and PMB reference: current SchemeBook source snapshot
Registered scheme directory
Find a medical scheme
Browse open and restricted schemes. Save a private shortlist for later reference.
0shortlisted
No matching schemes
Try another name or filter.
Prescribed Minimum Benefits
Search covered conditions and minimum treatments
Browse Diagnosis Treatment Pairs by clinical category, condition, DTP code or treatment — using a search-and-browse pattern inspired by the Australian Medical Costs Finder, but populated only with South African CMS PMB data.
Currently indexed
SchemeBook currently indexes this many parsed DTP records. The one-record difference is being reconciled before the catalogue is described as complete.
Clinical groupings
Browse the indexed conditions by broad clinical category when you do not know the DTP code or exact diagnosis wording.
Then check your scheme
Use the DTP record as the PMB starting point, then confirm DSP, authorisation, protocol, provider charges and your scheme's written funding decision.
South African health system
How to use public care
Start with the right level of care, then ask how referrals work in your province. Services and local processes can vary.
Start at a clinic
For routine primary care, find a nearby public clinic or community health centre. Ask about opening hours, what identification and records to bring, and how follow-up appointments work.
Get a referral when needed
The care team may refer you for tests, a specialist clinic or hospital treatment. Keep the referral letter, results, medicine list and appointment details together.
Know the urgent route
For a medical emergency, seek emergency care promptly. Ask the local facility or provincial health department about available services; do not wait for an online guide to assess symptoms.
Ask about charges and support
Public hospital charges may depend on the service and a patient's classification. Ask the facility's admissions or billing desk how your situation is assessed and what documents it needs.
National Department of Health ↗ · Government health services ↗
Guide to fees and costs
Plan for the full cost of care
A provider's charge, a scheme's recognised rate and the amount you pay can differ. This guide helps you get a case-specific estimate.
Before the appointment
Ask the practice for its consultation fee, whether it charges the scheme directly, which codes it expects to use and whether the provider is in your option's network.
Before tests or a procedure
Request a written estimate covering the facility, treating specialists, anaesthetist, pathology, imaging, medicines and follow-up. Confirm which services are billed separately.
Check your scheme
Give your scheme the proposed codes, provider names and facility. Ask about authorisation, benefits, limits, network rules, co-payments, PMB assessment and the amount it expects to fund.
Compare the answers
Match each quoted charge with the scheme's written response. Ask the provider and scheme to explain any possible shortfall before treatment, and save both documents.
What SchemeBook can and cannot show
The directory confirms scheme identity and access type; it does not contain current provider fees or option-specific payouts. Illustrative examples in the learning guide are not quotes. Ask the provider and your scheme for your actual figures.
Ask SchemeBook
Ask about your medical scheme
Pick the scheme, type the question and SchemeBook will show what can be verified.
71schemes ready to select
- 1ChooseSelect your scheme
- 2AskType or pick a question
- 3CheckSee the verified result
Your answer appears here
Start by choosing a scheme
Then ask in your own words or use one of the suggested questions. SchemeBook will never substitute information from a different scheme.
How SchemeBook verifies scheme informationView the Core ZA reference and planned source packs+
Built on verified reference layers
Reference layers
Every scheme answer combines national rules with documents for the selected scheme and benefit option.
Scheme source pack
Evidence reserved for every scheme
The same reviewed structure is used for all 71 schemes.
Cover explained
Five layers shape what happens
Select a layer to see what it controls and which terms are connected to it.
Understanding library
Go beyond the definition
Choose a topic for a practical explanation, worked example, common misunderstanding and questions to ask.
8deep-dive topics
Document decoder
Know what each document can prove
A document can answer one question and still leave another open. Use this guide to assemble the right evidence.
Read a claim result
What does the statement seem to show?
Choose the closest result. SchemeBook explains what it may mean and what to check next.
Plain-language glossary
Translate the terminology
Search common membership, benefit, provider, medicine, claim and dispute terms.
40terms shown
No matching term
Try a shorter or broader word.
Check the current rule
Official sources
SchemeBook explains the system in plain language. For a decision or dispute, confirm the position against your scheme's current registered rules and CMS guidance.