Scheme clar­i­fies PMB po­si­tion

Weekend Argus (Saturday Edition) - - GOODPASTIMES -

In an ar­ti­cle ti­tled “Med­i­cal scheme mem­bers lose out on PMB claims” (Per­sonal Fi­nance, Septem­ber 19), we re­ported that the Coun­cil for Med­i­cal Schemes had con­ducted an au­dit of four large med­i­cal schemes, in­clud­ing the Char­tered Ac­coun­tants Med­i­cal Aid Fund (Ca­maf), and found that 20 per­cent of pre­scribed min­i­mum ben­e­fit (PMB) claims had not been paid.

PMBs are ben­e­fits that schemes must, by law, pro­vide to all mem­bers.

Ca­maf has pointed out that it was one of four schemes that re­sponded to a re­quest for in­for­ma­tion from the coun­cil. The in­for­ma­tion from all four schemes was pooled and the find­ing was based on the com­bined in­for­ma­tion.

The scheme says no find­ing can be made against any of the in­di­vid­ual schemes, as any one scheme could be com­pletely com­pli­ant with PMB pay­ments.

The Coun­cil for Med­i­cal Schemes has con­firmed that this is in­deed the case. The coun­cil has also clar­i­fied that it used the word “au­dit” in a broad sense to de­scribe the ex­er­cise it car­ried out to de­ter­mine the ex­tent to which PMB claims were not be­ing paid.

Ca­maf says it is al­ways its in­ten­tion to com­ply with its le­gal obli­ga­tions in re­spect of PMBs, and so it pays for PMB con­di­tions in full on the terms stated in the Med­i­cal Schemes Act and its reg­u­la­tions.

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