Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.

PMBs are a feature of the Medical Schemes Act, and prescribes that medical schemes have to cover the costs related to the diagnosis, treatment and care of conditions that are included on the PMB List. 

These conditions often require access to innovative and costly treatments. For many Medical Aid members, access to these treatments for their PMB conditions is not a certainty, and Medical Schemes are continuously able to hide behind a variety of legal processes and procedures in an attempt to save costs for as long as possible. 

The Council for Medical Schemes (CMS) was established to supervise medical schemes in South Africa. In this role, its first priority is to protect the rights of consumers and to ensure that they are treated fairly. Unfortunately, CMS is under resourced, resulting in a less than desirable complaints process with lengthy turnaround times and often, little relief to the patient.

Our patient community is often on the losing end of the legislated complaints process, with many of our rare disease cases taking over 2 years to finalise. As it stands, we have a case which has been waiting for an appeal date for more than 15 months, during which time, the patient has been left untreated (more information at www.dearministerofhealth.org

As an active patient advocacy group, we are left no choice but to tackle the inefficiencies in our system by means of raising our voices as healthcare users, and engaging with the powers at be on improved solutions. 

It is imperative, that the Minister of Health, as the Constitutionally appointed custodian of all healthcare related matters within South Africa, provide oversight and support to the CMS To effectively and efficiently fulfil it’s responsibilities to medical scheme members with disputes about the conduct and decisions of their medical scheme., and that the necessary resources are provided to the Council to ensure it is able to fulfil its mandate. 

Kelly du Plessis

Founder & CEO - Rare Diseases South Africa NPC

www.dearministerofhealth.org