Understanding Prescribed Minimum Benefits (PMBs)

PMBs are guided by a list of medical conditions as defined in the Medical Schemes Act which are the minimum benefits every medical scheme member is entitled to by law. This means, even if your scheme has exclusions or waiting periods in place, or you've reached the limit for a certain benefit, you are still entitled to cover for certain conditions.

The Regulations to the Medical Schemes Act of 1998 require that medical schemes must provide cover for the diagnosis, treatment, and ongoing care of:

• 271 diagnoses and their associated treatment
• 27 chronic conditions (including HIV)
• Emergency treatment

How we pay your PMB claims

Benefit tip: Use a Designated Service Provider (DSP) to have your claim paid in full.

If you choose to use the DSPs, the Scheme will pay your medical expenses in full, from your Hospital Benefit. If you choose not to use a DSP, the Scheme will pay for medical expenses incurred while you are admitted to hospital, up to the Scheme Rate. You will be responsible for the balance as a co-payment.

Malcor has selected the following Mediclinic facilities as the Scheme's in-hospital DSP or 'network'.

• Busamed Gateway
• Busamed Hillcrest
• Life East London
• Life St George's

You can view the latest list of hospitals and other service providers at www.malcormedicalaid.co.za.

It's important to note that your hospital admission is subject to approval and preauthorisation. If you need to be admitted for emergency medical treatment, it's important to arrange for authorisation 72 hours after your admission or have a family member contact the Scheme to arrange this. Out-of-hospital PMB cover is also subject to approval and preauthorisation, so be sure to download the application form if you need this type of cover at www.malcormedicalaid.co.za.

By knowing your benefits, you can ensure that you get the cover and support for the best possible health journey with us.

Top tips: always obtain preauthorisation for your medical treatment and use a DSP for full coverage.