Eugene Gruss

The Confusion If you have ever read your medical aid benefit guide, you have almost certainly seen references to "100% of the scheme rate", "200% of the scheme rate" or "300% of the scheme rate" for in-hospital specialists. Most members have no idea what this means in practice — and schemes do not go out of their way to explain it. What is the Scheme Rate? Every medical scheme sets its own tariff — a list of what it considers a fair and reasonable fee for each medical procedure or...

The Short Answer A PMB — or Prescribed Minimum Benefit — is a set of medical conditions and treatments that every registered medical scheme in South Africa is legally required to cover in full, regardless of which plan you are on or how much you have left in your medical savings account. In plain language: if you have a condition that falls under the PMB list, your scheme cannot refuse to pay for its treatment by claiming you have exhausted your benefits. Where Does the PMB List Come From?...