Prescribed minimum benefits (PMBs)

PG Group Medical Scheme approves funding for benefits based on treatment protocols for PMB conditions, following guidelines from healthcare authorities and best clinical practices.

Prescribed minimum benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum healthcare services, irrespective of their benefit option.

Click here to read more and view the PMB Chronic Disease List (CDL).

Application for out-of-hospital treatment of a PMB condition

This form is to be completed by you, as the member, and your treating doctor. Please read each section carefully to ensure that you comply with all the requirements.

Understanding prescribed minimum benefits (PMBs)

The following extracts from the Council for Medical Schemes' (CMS) website will assist you in understanding prescribed minimum benefits (PMBs).
For more information on PMBs, please visit the CMS website at www.medicalschemes.com.

Required information

The Scheme's registered name

PG Group Medical Scheme
The main member and the patient treated

The main member's name and the name of the patient treated (main member or dependant) as registered and indicated on the membership card
Membership number

The Membership number as indicated on the membership card
The doctor's practice number

Doctors registration number on the Health Professions Council of South Africa
ICD-10 code(s)

This is a diagnosis code, eg."J11.1"
Signed Proof of Payment

Proof of payment signed by the member and indicated as 'PAID' (where applicable).

Required information

Your membership number

Your Medical Aid Membership Number on your card
The name and practice details of the admitting doctor

The Doctor who is to performing the procedure should provide this
The date of admission to hospital or clinic

Date at which the patient gets admitted or Procedure Date if it occurs on the same day
The name of hospital or clinic

The Doctor, Hospital or Clinic can provide
The medical condition

The Doctor who is to performing the procedure should provide this
The diagnosis / the ICD-10/ Procedure codes / The type of procedure

The Doctor who is to perform the procedure needs to provide
The expected length of stay

How long the patient is expected to stay in the Hospital / Clinic

1Basic Contributions
2Late Joiner Penalties

person

Main Member

person_add

Dependants

Adult Dependants

Minor Dependants

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Any subsidies paid by the employer in respect of qualifying continuation members will continue. Active principal members who are part of the bargaining sector will continue to receive the employer's subsidy in terms of their current legal employment agreement. Active principal members who have converted to total cost of employment (TCoE) remuneration packages, pay full contribution indicated above.

Pensioners and retirees' income (that is used to determine their income bands and contributions) is based on 50% of their last BPSA pensionable earnings before retirement. This amount is increased by the consumer price index (CPI) every year.

Are you joining the Medical Aid on the same date you are joining the company?

			Years without Medical Aid cover
1	Main Member
{{$index + 2}}	Adult Dependant

Years Without Medical Aid Cover

Up to the age of 21, a dependants cover is regarded as years without cover. Medical Insurances not registered to the Council of Medical Schemes are not regarded as credible cover. Medical cover overseas is also not regarded as credible cover.

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+ Late Joiner Penalties R{{addUpTotal(0,latejoiner_total_member,latejoiner_total_dependant) | number: 2}} CALCULATING...

Total Contributions R{{addUpTotal(total,latejoiner_total_member,latejoiner_total_dependant) | number: 2}} CALCULATING...

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PG Group Medical Scheme

PG Group Medical Scheme

Prescribed minimum benefits (PMBs)

Application for out-of-hospital treatment of a PMB condition

Understanding prescribed minimum benefits (PMBs)

Required information

The Scheme's registered name

The main member and the patient treated

Membership number

The doctor's practice number

ICD-10 code(s)

Signed Proof of Payment

Required information

Your membership number

The name and practice details of the admitting doctor

The date of admission to hospital or clinic

The name of hospital or clinic

The medical condition

The diagnosis / the ICD-10/ Procedure codes / The type of procedure

The expected length of stay

Main Member

Dependants

Years Without Medical Aid Cover

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