Prescribed Minimum Benefits (PMBs)

Patient Information for Prescribed Minimum Benefits (PMBs)

This information has been prepared to assist you in understanding the legislation, administrative processes and your rights regarding Prescribed Minimum Benefits (PMBs).  It is important that you read this information carefully and completely.

For Discovery Health patients, they have published a guide which you can download here – Guide-to-Prescribed-Minimum-Benefits.

WHAT YOU MUST DO IF YOU HAVE A PMB CONDITION

  1. Please read the law regarding PMBs provided and familiarize yourself with your statutory rights and responsibilities.
  2.  If you believe you have a valid complaint against your scheme, or would like additional information regarding PMBs, please contact the Council for Medical Schemes (CMS) for further assistance. Their details are as follows:              Tel: 012 431-0500 / 0861 123 267                 Fax:     012 430-764                    E-mail: support@medicalschemes.com        www.medicalschemes.com
  3. It is your responsibility to inform your medical scheme of the diagnosis and to inquire whether any additional program registrations are required, such as chronic conditions or oncology benefits. It is also your responsibility to register for these programs as soon as possible after the diagnosis has been definitely secured. You may need to deliver the appropriate pathology reports and other supportive documentation.
  4. I am a designated service provider (DSP) for the following scheme types only: Discovery Classic Saver, Discovery Classic Comprehensive and Discovery Executive. If you are on these plans, your account should be paid in full. If you are not, you should discuss your surgery with your Scheme and ascertain if they have a DSP agreement with another surgeon and if that surgeon is able to provide you with the surgical procedure that you require.
  5. If you are not a member of the above schemes for which I am a DSP, and you choose to have your surgery with me, then according to the law, you may be liable for a co-payment as per the rules of your scheme.
  6. If you have been referred to me as a hospital inpatient, in many cases this would constitute an “involuntarily obtained service” and according to the law would require the scheme to pay in full. Such cases are typically fraught with significant administrative burdens. It remains the responsibility of the patient or their relatives to persuade their scheme to abide by the law. My office will assist as much as possible, but the responsibility remains that of the patient and/or their guarantor.
  7. All patients should be aware that final payment of accounts will remain the sole responsibility of the patient and/or their guarantor, the applicability of a PMB diagnosis notwithstanding. We require payment in full within 14 days of the procedure, as per my terms and conditions of service.