PMB complaints remain high
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