Scheme clarifies PMB position
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.