PMB com­plaints re­main high

CityPress - - Business -

Over the past year, the Coun­cil for Med­i­cal Schemes re­ceived 3 876 new com­plaints and re­solved 5 491 com­plaints, in­clud­ing a back­log from the pre­vi­ous year.

Com­plaints re­lated mostly to med­i­cal schemes not pay­ing for pre­scribed min­i­mum ben­e­fit (PMB) claims. PMBs are the min­i­mum ben­e­fits your scheme must legally cover in full, as per the healthcare provider’s in­voice.

Your scheme is not al­lowed to use your per­sonal med­i­cal sav­ings ac­count to pay for PMB con­di­tions.

The di­ag­no­sis, treat­ment and care of about 300 of the most se­ri­ous and ex­pen­sive health con­di­tions, in­clud­ing any emer­gency con­di­tion, fall un­der PMBs.

These in­clude as many as 270 dis­eases, in­clud­ing TB and can­cer, and 25 chronic con­di­tions, in­clud­ing asthma, epilepsy and hy­per­ten­sion.

SCHEMES WITH THE MOST COM­PLAINTS

Sev­eral schemes have showed up over the past two years as prone to com­plaints.

Open schemes with the most com­plaints:

1. Spec­tramed 2. Res­o­lu­tion Health Med­i­cal Scheme 3. Com­mu­nity Med­i­cal Aid Scheme 4. Ge­n­e­sis Med­i­cal Scheme 5. Med­shield Med­i­cal Aid Scheme

Closed schemes with the most com­plaints:

1. Univer­sity of Wit­wa­ter­srand Med­i­cal Aid Scheme 2. Net­care Med­i­cal Scheme 3. Hori­zon Med­i­cal Scheme 4. Grin­tek Elec­tron­ics Med­i­cal Aid Scheme 5. Ned­group Med­i­cal Aid Scheme

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