Prescribed Minimum Benefits

No matter what plan or medical scheme you decide on, there are some common benefits that apply to all members on all plans. In terms of the Medical Schemes Act and its regulations, all medical schemes have to cover the costs related to the diagnosis, treatment and care of any life-threatening emergency medical condition, a defined set of 270 diagnoses as well as 27 chronic conditions. These conditions and their treatments are known as the Prescribed Minimum Benefits (PMB).The PMBs also include HIV or AIDS treatment and cover for certain diagnosis-based procedures.

In most cases, TFG Medical Aid Scheme plans offer benefits which cover far more than the Prescribed Minimum Benefits.

To access Prescribed Minimum Benefits, there are rules that apply:

  • The condition must be part of the list of defined PMB conditions
  • The treatment needed must match the treatments in the defined benefits
  • Members must use the scheme’s designated healthcare service providers.

How to apply for PMB cover

  1. If a member wants to apply for cover, he or she should:
  2. Download and print the applicable PMB application form which can be accessed here,
  3. Complete the application form with the assistance of your doctor

Send the completed, signed application form, along with any additional medical information, by email or by fax. The e-mail address and fax number can be found on the application form.

For more information regarding cover for PMB on your chosen benefit plan please consult with your benefit plan guide by following the links provided below:

TFG Health Benefit Guide

TFG Health Plus Benefit Guide