Profmed now pays PMB claims in full

November 28, 2011

Profmed, the last medical scheme to hold out against paying prescribed minimum benefit (PMB) claims in full, this week bowed to pressure from the Registrar of Medical Schemes and agreed to pay these claims in full as invoiced.

Graham Anderson, Profmed’s principal officer and chief executive, says the board of trustees believes it acted in members’ best interests by not paying claims for PMBs at whatever rate a healthcare provider charged, but the board decided not to put the scheme at risk of being deregistered.

Profmed is a restricted scheme for graduate professionals. It has about 25 000 members and covers about 62 800 lives.

Read the full article in ~uPersonal Finance#www.iol.co.za/business/personal-finance/profmed-now-pays-pmb-claims-in-full-1.1186851~

PMBs are benefits that schemes must by law provide, and cover all emergencies, about 270 life-threatening conditions and some common chronic conditions.

Although Profmed has not been served with a notice that it would be deregistered, Dr Monwabisi Gantsho, the Registrar of Medical Schemes and the chief executive of the Council for Medical Schemes, told Business Report, Personal Finance’s sister newspaper, earlier this week that his office was in the process of deregistering “a scheme” that was deliberately not complying with a regulation under the Medical Schemes Act that states that schemes must pay PMB claims in full.

Gantsho confirmed yesterday that all medical schemes have now agreed to pay PMB claims in full as invoiced. Following rulings by the Council for Medical Schemes’s Appeal Board in 2008, the council has interpreted the regulation to mean that schemes should pay PMB claims at whatever rate a healthcare provider charges.

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