Comprehensive Guide to Prescribed Minimum Benefits (PMBs) for Medical Aid in South Africa (2025)
Introduction
When comparing medical aid plans in South Africa, understanding Prescribed Minimum Benefits (PMBs) is essential. PMBs are legally mandated by the Medical Schemes Act to ensure all medical aid members receive coverage for essential, life-saving care—regardless of the plan tier.
This guide outlines what PMBs cover, how they impact your choice of plan, and which providers offer the strongest support for chronic conditions, emergency care, and hospitalisation under the PMB framework in 2025.
What Are Prescribed Minimum Benefits?
PMBs guarantee access to treatment for:
- 27 chronic conditions listed in the Chronic Disease List (CDL) such as diabetes, epilepsy, asthma, and hypertension
- Emergency medical conditions where immediate treatment is required to prevent death or serious long-term harm
- In-hospital treatments for a range of conditions and procedures covered under defined diagnostic treatment pairs (DTPs)
All registered medical schemes in South Africa must include PMB cover—even in their most basic plans.
For more insight into chronic condition support, see our dedicated page on cover for chronic illnesses.
Comparing Medical Aid Providers on PMBs (2025)
Provider | Plan Name | Monthly Premium (± 2025) | Chronic PMB Conditions Covered | Hospitalisation Coverage | Co-Payments & Restrictions |
Discovery Health | Classic Saver | R4,535 | Yes – Full PMB support | Private hospitals, no annual limit | Some network/DSP restrictions apply |
Bonitas | BonComprehensive | R3,872 | Yes – Chronic Disease List supported | Full cover at network hospitals | Co-payments outside networks |
Momentum Health | Ingwe Plan | Income-based | Yes – Full PMB conditions | Covered at network/emergency facilities | Limited access outside hospital network |
If you’re considering budget options, explore entry-level hospital plans to see how PMBs are supported on lower-tier plans.
Best PMB Plan Matches by Profile
Individuals with Chronic Conditions
Plans like Discovery Classic Saver and Bonitas BonSave offer strong chronic cover, with access to medication and specialist consultations for all CDL-listed conditions. They’re suited to people managing long-term conditions like hypertension or diabetes.
Low-Income Members
Momentum’s Ingwe Plan provides affordable access to PMB treatment through a defined network of hospitals and doctors. It’s ideal for students, young professionals, and entry-level earners who need essential protections without high premiums.
Retired or Elderly Patients
Older members benefit most from comprehensive plans that include frequent hospital visits and full access to PMB services. Bonitas in particular offers well-rounded cover that includes both chronic and hospital-based benefits important for age-related conditions.
Key Considerations When Choosing a PMB-Supporting Plan
Always check if your plan covers PMBs in full when using the scheme’s designated providers.
Most plans require PMBs to be accessed through designated service providers (DSPs). Out-of-network treatment might result in out-of-pocket costs unless it was an emergency.
Even the most affordable plans are required to cover PMBs. Just ensure you understand the hospital network rules and limitations of your chosen plan.
Frequently Asked Questions
The PMBs include:
- 27 chronic illnesses (CDL)
- Medical emergencies
- A wide range of hospital-based treatments defined by diagnostic-treatment pairs
Yes. PMB coverage is legally mandatory across all registered schemes and plan types.
Usually, you’ll need to use the medical scheme’s network of providers or obtain pre-authorisation for non-emergency treatment. Emergency care is automatically covered.
Understanding PMBs is crucial when evaluating South African medical aid plans. These benefits form the foundation of basic healthcare protection and ensure that life-saving treatment is available to all members, regardless of their plan level.
Plans like Discovery’s Classic Saver, Bonitas’s BonSave, and Momentum’s Ingwe Plan all comply with PMB requirements, but the level of flexibility, medication support, and provider access can differ greatly.
To explore which medical aid plans best match your PMB needs, visit our full medical aid comparison section or browse specific options for chronic conditions, hospital plans, or income-based schemes.