Prescribed Minimum Benefits (PMB) is a set of defined benefits that ensure that members have access to certain minimum health services, regardless of the benefit option you have selected. In accordance with the Medical Scheme’s Act, medical schemes have to cover the costs related to these conditions including: – Any emergency medical admission and the twenty-six (26) chronic medical conditions.
Your doctor will guide you in determining whether your condition falls into one of the PMB conditions. It is vital that members obtain a Pre-Authorisation for any PMB condition as the Scheme may require you to be referred to a designated service provider so that all associated costs are in line with SAMWUMED’s Scheme Rules.
Twenty-Six (26) Chronic Medical Conditions
| Addison’s disease (progressive anaemia) | Crohn’s disease (swelling of the intestines) |
| Asthma (attacks of spasm & difficulty in breathing) | Diabetes insipidus |
| Bronchiectasis (chronic lung disease) | Diabetes mellitus types 1 & 2 |
| Cardiac failure (Heart disease) | Dysrhythmias (irregular heartbeat) |
| Cardiomyopathy (heart disease) | Epilepsy (convulsions). |
| Chronic obstructive pulmonary disorder (lung disease) | Glaucoma (gradual loss of sight). |
| Chronic renal disease (kidney disease) | Haemophilia (severe bleeding) |
| Coronary artery disease (heart disease) | HIV/Aids |
| Hyperlipidaemia (too much fats in the blood or cholesterol) | Parkinson’s disease (body shakes) |
| Hypertension (abnormally high blood pressure) | Rheumatoid arthritis (inflammation in the joints ) |
| Hypothyroidism (underactive thyroid) | Schizophrenia (mental disorder) |
| Multiple sclerosis (chronic central nervous system disease. It affects the brain, spinal cord, and optic nerves) | Systemic lupus erythematosus (A chronic inflammatory condition) |
| Bipolar Mood Disorder (mental disorder) | Depression |
| Eczema (a medical condition in which patches of skin become rough and inflamed with blisters which cause itching and bleeding). | Gout (intense joint pain) |
| Gastro-oesophageal reflux disease (GORD | Menopause (the end of menstruation in women aged between 45 and 50) |
