PMB Battle Moves to High Court

There is a tug of war that has been playing out in the Western Cape High Court since September last year. It started when Genesis, a medical aid provider, lodged an application against the Health Minister regarding constitutional provisions overseeing Prescribed Minimum Benefits, commonly referred to as PMBs. According to the medical scheme, the minister only has powers to say which conditions can be included under PMBs but not how schemes should pay for claims made by beneficiaries with such conditions.

What is a PMB

PMB Court CasePMBs are a set of benefits every policyholder should have access to regardless of the product they have signed up for. Apart from emergency medical conditions of any nature, treatment for diabetes, epilepsy, HIV and TB among other maladies is required to be catered for in full by medical aid providers under PMBs. This ensures that any beneficiary suffering from these conditions can receive continual health care without having to pay for anything from their own savings. This is in line with the government’s objective of making health care accessible to all South Africans who need it, regardless of the nature of their ailment without discrimination.

Advocacy Groups Protest

Though the minister’s office has so far not contested the application, a group going by ‘friends of the court’ has. Consisting of an assortment of advocacy groups including The Treatment Action Campaign (TAC), People Living With Cancer (PLWC) and South African Depression and Anxiety Group (SADAG), they wish to block Genesis’ application. They are of the opinion that if Genesis wins, patients will pay the price. Joining the friends of the court are the Council for Medical Schemes, the Hospital Association of South Africa, the Infertility Awareness Association of South Africa and the Multiple Sclerosis Society of South Africa.

PMB BanPLWC, SADAG and the other patient advocacy groups acknowledge that the health minister is not empowered by the constitution to demand the payment of PMBs in full sans co-payments from medical schemes. But they are adamant that this loophole be addressed so that the right of a patient to healthcare not be sidelined. A group of lawyers going by the name ‘Section 27’ are representing these groups in court. Their submission was heard by the high court on June 18 and the matter has yet to reach a conclusion.

* Explanation of what Prescribed Minimum Benefits are all about: Watch the YouTube video