Prescribed Minimum Benefits
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Prescribed Minimum Benefits

Interpretation and application of the Prescribed Minimum Benefits 

What is the current situation, and where to from here? 


The Prescribed Minimum Benefits (PMBs) are a set of nearly three hundred defined benefits to which all medical scheme members are entitled, regardless of the option they have selected. The PMBs were first introduced when the Medical Schemes Act of 1998 was promulgated. The issues around payment and treatment related to PMBs remain vexing and are the source of most complaints received by the Council for Medical Schemes.


IHRM has developed a two-day PMB programme designed to provide call centre agents, case managers, fund managers, claims assessors, medical scheme trustees and principal officers with a working knowledge of medical scheme benefit design, managed care, and the interpretation and application of the PMBs. 

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Programme

Introduction to medical scheme benefit design

       Benefit design

       Medical scheme expenditure

       Rationale for the introduction of PMBs

       What are the PMBs?

        -   Underwriting in the context of PMBs

        -   Exclusions – do they apply to PMBs?

       The Diagnosis and Treatment Pairs (DTPs) 

       -   Entitlement to benefits for the DTPs.Identifying ‘Emergency conditions’Examining the Chronic Disease ListThe implications of PMBs for                medical schemes

      -   The payment of PMBs

Risk management for the PMBs

Managed care programmes
-   Standards for managed care
-   Designated Service Provider Networks
The PMB Code of Conduct 2017
The complaint resolution process to be followed by medical schemes, members and providers
Rights and responsibilities of medical schemes, members and providers

Proposed changes to the basket of PMBs
-   The Council for Medical Schemes Exemption Framework
-   Development of Low-Cost Benefit Options
-   Recommendations by the Health Market Inquiry

This programme includes both theory and practical case studies. 

Register for the two-day facilitation programme and complete an online assessment. On successful completion of the online assessment you receive a certificate of attendance.

Cost

R3 500 excluding VAT per delegate

Dates

15 and 16 April 2021

09:00 to 15:30 

Click here to download the registration form

IHRM is facilitating the programme via Teams Microsoft online meetings. You can attend from the comfort of your home or office. 

You do require internet connectivity. You can access the training material via an eLearning platform, and are further supported by WhatsApp groups and email. 

This programme is also offered as an in-house customised programme. 

Contact us on info@ihrm.co.za  or on 011 726 7482 for more information