Bestmed covers the diagnosis, treatment and care costs of Prescribed Minimum Benefits (PMBs) by law from Scheme benefits to all members.
Prescribed Minimum Benefits (PMBs) are minimum benefits that, by law, must be provided to all medical scheme members. This includes the provision of diagnosis, treatment, and care costs for:
You need to keep the following in mind when applying for a specific healthcare service to be evaluated and approved from the PMB risk pool:
PMB applications can be
Please note: Based on the stipulations in the Medical Schemes Act and the Regulations of the Act, PMBs are funded from the Scheme’s risk pool. Therefore, a structured PMB process, which meets legislative requirements and supports cost containment, has been implemented for Bestmed members.
You and your healthcare provider will receive an email with all the information relevant to the PMB Department's decision.
If an application has been approved for retrospective healthcare service(s) rendered, Bestmed will arrange for the claim(s) to be processed from the PMB benefit. You will be able to view all corrections to claim(s) on the reconciled emailed and/or posted claims statement.
Bestmed will arrange for the short payment to be made to the provider, or we will make a payment into your account upon receiving proof of payment from you.
GAP cover may provide cover for the shortfall of in-hospital accounts which are not listed PMB cases. If the hospitalisation was for a listed PMB, you or the relevant healthcare provider's practice needs to apply directly to Bestmed to possibly approve the shortfall as a PMB.
Making use of DSPs may ensure that claims are paid in full. Exceptions are made in case of emergencies, where no DSP is available or where you cannot be accommodated within a reasonable time. You have the choice to voluntarily use non-network providers. However, they may charge higher fees or co-payments for your own account.