Interpretation and application of the
Prescribed Minimum Benefits
What is the current situation, and where to from here?
The Prescribed Minimum Benefits (PMBs) are a set of nearly three hundred defined benefits to which all medical scheme members are entitled, regardless of the option they have selected. The PMBs were first introduced when the Medical Schemes Act of 1998 was promulgated. The issues around payment and treatment related to PMBs remain vexing and are the source of most complaints received by the Council for Medical Schemes.
IHRM has developed a two-day PMB programme designed to provide call centre agents, case managers, fund managers, claims assessors, medical scheme trustees and principal officers with a working knowledge of medical scheme benefit design, managed care, and the interpretation and application of the PMBs.
Introduction to medical scheme benefit design
Medical scheme expenditure
Rationale for the introduction of PMBs
What are the PMBs?
- COVID-19 as a PMB
- Underwriting in the context of PMBs
- Exclusions – do they apply to PMBs?
The Diagnosis and Treatment Pairs (DTPs)
- Entitlement to benefits for the DTPs.
Identifying ‘Emergency conditions’
Examining the Chronic Disease List
The implications of PMBs for medical schemes
- The payment of PMBs
Risk management for the PMBs
Register for the two-day facilitation programme and complete an online assessment. On successful completion of the online assessment you receive a certificate of attendance.
R3 500 excluding VAT per delegate
FSCA CPD Points: 15
15 and 16 April 2021
09:00 to 15:30
IHRM is facilitating the programme via Teams Microsoft online meetings. You can attend from the comfort of your home or office.
You do require internet connectivity. You can access the training material via an eLearning platform, and are further supported by WhatsApp groups and email.