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Getting your claim paid as PMB

What is the meaning of PMB?GETTING YOUR CLAIM PAID AS PMB

Prescribed Minimum Benefits.
This means  there are certain life treating conditions that your medical aid needs to pay for  as a PMB condition.

What is the meaning of life threatening conditions and what conditions are they ?

Life threatening conditions means you as the patient or your family member or friend needs immediate treatment or that person could die. 

Examples of life threatening conditions are:

MVA ( Motor Vehicle Accident )

  • Diabetes
  • Asthma
  • Stroke
  • Epilepsy

These are only a few examples of PMB conditions.

What do you need to do to get a claim paid as a PMB condition?

  • Firstly you need to qualify for PMB cover.  This means you will be a category B or C client.
  • You need a detailed account from your doctor or hospital.
  • Your claim will be submitted as a normal claim for payment to your medical aid.
  • Should there be a short payment on the account, find out what category client you are and if you do qualify for PMB cover.
  • If you do qualify and your claim was short paid, confirm this from your medical aid.
  • The medical aid will confirm if the case do qualify as a PMB or not.
CareLine Group is here to assist you in looking at many different medical aids. Seeing what medical aid would suite you best.
Contact CareLine Group on 0861 45 00 45 or compete our Contact Us form and we will get back to you.