Circular 26 of 2026: Request for Membership and Claims Data for the Costing of the Proposed Primary Healthcare Service Benefits Package
The Council for Medical Schemes (CMS) requests medical schemes and administrators to submit beneficiary-level membership and claims data to update the costing of the proposed Primary Healthcare (PHC) service benefits package as part of the Prescribed Minimum Benefits (PMB) Review.
The requested data must cover the period 1 January 2023 to 31 December 2025 and will support the PMB Review Costing Committee in determining the cost and affordability of the proposed PHC package, as well as subsequent affordability analyses and implementation planning. The detailed data specification is contained in Annexure A.
Medical schemes are required to submit the requested information electronically by 15 October 2026. The secure submission mechanism and file transfer instructions will be communicated separately by the CMS.
The CMS will host a technical engagement session to provide clarification on the data specification and address technical queries:
- Date: 29 September 2026
- Time: 09:00–12:00
- Platform: Microsoft Teams
Register for the technical engagement session here.
The CMS emphasises that the submission of complete and accurate data is critical to ensuring that the updated costing of the proposed PHC package is evidence-based, transparent and reflective of current healthcare utilisation.
Download the full Circular here.