SchemeBookUnderstand the system. Know what to ask.
by RiskAtlas
A legally mandated minimum level of cover every scheme must provide.
By law, every South African medical scheme must cover a defined list of conditions and emergencies in full, regardless of which plan you're on — these are the Prescribed Minimum Benefits (PMBs). PMBs exist so that serious or life-threatening conditions aren't left uncovered because of plan limits or exclusions.
More jargon
Open scheme · Restricted scheme · CDL (Chronic Disease List) · DTP (Diagnosis Treatment Pair) · Co-payment · Designated Service Provider (DSP) · Waiting period · Late-joiner penalty · Savings account / above-threshold benefit · Medical scheme · Medical aid · Medical insurance · Benefit option · Principal member · Dependant · Contribution · Underwriting · Condition-specific waiting period · Emergency medical condition · Medical savings account · Self-payment gap · Benefit limit · Scheme tariff or rate · Out-of-pocket payment · Provider network · Formulary · Generic medicine · Clinical protocol · Pre-authorisation · Managed care · Claim statement · Tariff shortfall · Claim rejection · Clinical motivation · Internal appeal · CMS complaint · Registered scheme rules