- Annexure A of the General Regulations made in terms of the Medical Schemes Act, 131 of 1998 provides a schedule of “diagnosis and treatment pairs”, which cumulatively comprise the prescribed minimum benefits (PMBs) to be provided to beneficiaries of medical schemes in terms of section 29(1)(o) of the Act.
- This list is not a legislated document and should be used as a basic guideline. It may not be used as the legal interpretation of PMB conditions.
- In the event of conflict between this interpretation and the definition of conditions set out in Annexure A to the regulations, the definition of conditions contained in the regulations will prevail.
- The codes in this guideline may be associated with the cause of the condition, or may describe a functional state. The inclusion of the code here does not imply that the condition automatically qualifies for prescirbed minimum benefits. These codes only serve to assist in the identification of possible PMB conditions. To qualify as a PMB condition, the condition must fully meet the criteria in the PMB descriptor