Prescribed Minimum Benefits

Prescribed Minimum Benefits (PMBs) Explained (2026)

Prescribed Minimum Benefits (PMBs) are a set of essential healthcare benefits that every registered medical scheme in South Africa must cover in full, on every plan, by law. They guarantee access to care for serious, chronic and emergency conditions no matter which option you choose. This guide explains what PMBs cover, how a scheme decides whether something qualifies, and how Designated Service Providers affect what you pay.

What PMBs cover

PMBs cover the diagnosis, treatment and care of three groups of conditions:

• Any emergency medical condition, where sudden onset means delay could cause serious harm.
• A defined list of around 270 conditions set out as Diagnosis and Treatment Pairs (DTPs), each linking a diagnosis to a broad course of treatment.
• 26 chronic conditions on the Chronic Disease List (CDL), covering medicine plus related consultations and tests.

Every registered scheme must cover these in full, regardless of the plan you are on.

Every plan must cover PMBs

Even the most basic, lowest-cost option must cover PMBs in full. A scheme cannot refuse PMB cover because you chose an entry-level plan. This is the legal safety net that sits underneath every medical scheme option in South Africa.

How a scheme decides if something is a PMB

PMB status is decided on diagnosis, not on how a condition arose. The treating doctor looks at the symptoms and the diagnosis to determine whether the condition is on the PMB list. Accurate ICD-10 diagnosis coding on the claim is important, because the code is how the scheme identifies a PMB.

Designated Service Providers and co-payments

A scheme may require you to use a Designated Service Provider (DSP), a hospital, doctor or pharmacy it has contracted for PMB care. If you use the DSP, PMBs are paid in full. If you voluntarily use a non-DSP when one was reasonably available, the scheme may apply a co-payment. In a genuine emergency, or where no DSP was reasonably available, PMB care must be paid in full at any provider. This is set out in Regulation 8 of the Medical Schemes Act regulations.

Common misconceptions

• Cheaper plans still cover PMBs in full, this is a legal requirement on every option.
• PMBs are not only the chronic list. Many are emergencies or one of the roughly 270 Diagnosis and Treatment Pairs.
• Cover is not unlimited everywhere. Voluntarily using a non-DSP can trigger a co-payment.

Related guides

• Medical aid waiting periods
• Late-joiner penalties
• Medical aid network plans
• Compare medical aid schemes

How a broker helps

A registered broker conducts a needs analysis (required under the FAIS Act) covering your health needs, chronic conditions, family composition, hospital preferences and budget, then maps those needs to the right plan across the open schemes. Curemed is FSP 44098 and accredited by the Council for Medical Schemes as ORG 163. See our credentials.

Frequently asked questions