Prescribed Minimum Benefits (PMBs) are a legally mandated set of conditions every registered medical scheme must cover in full, on every option, regardless of price.
Defined under the Medical Schemes Act 131 of 1998, not by Mzansi Health.
The Chronic Disease List covers conditions like diabetes, asthma and hypertension in full.
No option, however basic, may exclude emergency medical treatment.
| Category | Detail |
|---|---|
| Prescribed Minimum Benefits (PMBs) | 271 diagnosis-treatment pairs, covered in full on every option |
| Chronic Disease List (CDL) | 26 chronic conditions, covered in full on every option |
| Emergency medical conditions | Always covered, cannot be limited by any option |
| Who sets these benefits | The Council for Medical Schemes, under the Medical Schemes Act 131 of 1998 |
No — PMBs must be covered in full by every registered medical scheme option, by law, regardless of which option you're on.
Schemes may direct you to a designated service provider network for PMB conditions to avoid a co-payment, but emergency treatment is always covered.
Yes — PMBs and the Chronic Disease List are set by law and apply identically across every registered medical scheme in South Africa.
A Mzansi Health consultant can confirm your specific PMB and chronic benefit entitlements — at no cost.
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