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| Why do we have PMBs? |
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| There are two main reasons why PMBs were
created: |
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| 1. |
To ensure that medical scheme beneficiaries
have continuous healthcare. This means that even if a member’s
benefits for a year have run out, the medical scheme has
to pay for the treatment of PMB conditions. |
| 2. |
To ensure that healthcare is paid for by
the correct parties. Medical scheme members with PMB conditions
are entitled to the specified treatments and these have to
be covered by their medical scheme, even if the patients were
treated at a state hospital. |
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| But there are other valid reasons too: |
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| 1. |
To provide minimum healthcare to everybody
who needs it, regardless of their age, state of health or
the medical scheme cover option they belong to.
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| 2. |
PMBs have a part to play in ensuring that medical schemes
remain financially healthy. When beneficiaries receive good
care on an ongoing basis, their general wellness improves,
resulting in fewer serious conditions that are expensive
to treat. |
| 3. |
To protect the interests of medical scheme beneficiaries by ensuring, for instance, that schemes first
cover essential treatments before setting funds aside for discretionary
services. |
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