PMBs and Chronic Medication
Prescribed Minimum Benefits
Prescribed Minimum Benefits (PMBs) are a feature of the Medical Schemes Act 131 of 1998, in terms of which medical schemes are obliged by law to cover the costs related to the diagnosis, treatment and care of:
- Any emergency medical condition
- A limited set of 270 medical conditions (defined in Diagnosis Treatment Pairs) and
- 25 Chronic conditions (defined in the Chronic Disease List).
How to find out more about Prescribed Minimum Benefits?
To find out more about Prescribed Minimum Benefits:
- Visit the Council for Medical Schemes' PMB page for a definition of an emergency medical condition
- Access the Council for Medical Schemes' Consumer Guide: Prescribed Minimum Benefits and Chronic Medication booklet
- Read through Bankmed Medical Schemes' Frequently Asked Questions (FAQs)
- Scroll down to page 31 (Annexure A) for a list of the 270 Diagnosis and Treatment Pairs (extracted from the Regulations governing the Medical Schemes Act).
Applying for Chronic Medication
Download the application form for Chronic Medication for a Prescribed Minimum Benefit condition (Basic and Essential Plans)
Download the application form for Chronic Medication for a Prescribed Minimum Benefit condition (Core Saver, Traditional, Comprehensive and Plus Plans)
Medicine Advisory Services (chronic medication)
Bankmed Medicine Advisory Services aim at providing you with a structured way to achieve the desired results with your medication usage, especially with Chronic Medication.
To obtain more information on how Medicine Advisory Services work and how you can benefit from it, download the Medicine Advisory Services brochure.
Should you not use Chronic Medication for the treatment of your Prescribed Minimum Benefit condition, kindly download an application form to access additional insured benefits.
Delivery method for Chronic Medication
Basic and Essential Plans
You will be able to select from three delivery options for your Chronic Medications.
DSP (Designated Service Provider) pharmacies
You have the option of collecting your Chronic Medication from any one of the DSP pharmacies. Visit www.bankmed.co.za for the full list of DSP to select from.
Selected GP Provider
You may also choose to collect your Chronic Medication from your chosen GP, should the GP be geared for this process. You will need to confirm this with the GP.
Contact details for Chronic Illness Benefit authorisations and registration
To obtain an immediate chronic medicine authorisation, your doctor or pharmacist may contact Bankmed’s Chronic Managed Care Department on 0800 132 345 as a direct line or 0800 BANKMED (0800 226 5633). Clinical entry and verification criteria will be applied.
Alternatively, application forms may also be completed by your doctor which you may download from the here.
The completed form for Core, Saver, Traditional, Comprehensive and Plus Plans should be returned to:
Fax: 011 770 6247
The completed form for Essential and Basic Plans should be returned to;
Fax: 011 539 7000