Your medical scheme is obliged to pay for certain prescribed minimum benefits (PMBs) that enable you to get the right treatment and protection from big medical bills. PMBs cover medical emergencies, life- threatening conditions and certain common chronic conditions. But the system isn't perfect. The Council for Medical Schemes reported in its latest annual report that it is investigating the country's two largest medical schemes, Discovery Health Medical Scheme and the Government Employees Medical Scheme, for failure to pay PMB claims in full as required under the Medical Schemes Act.
The South African Private Practitioners Forum (SAPPF), which represents several specialist doctor groups, said while there are specific problems with the PMB claims at these schemes, its members found 21,000 examples in one week from all schemes of PMB claims that were either not paid, short paid or paid from members' savings accounts in contravention of the Medical Schemes Act. SAPPF consultant ...
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