Prescribed Minimum Benefits (PMBs), according to the Council for Medical Schemes, is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the option they have chosen.

PMBs are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of:

• Any emergency medical condition.
• A limited set of 270 medical conditions (defined in the Diagnosis Treatment Pairs).
• 25 chronic conditions (defined in the Chronic Disease List). 

The importance of ICD-10 codes:

ICD-10 is a diagnostic coding standard that was adopted by the National Department of Health in 1996 as the national standard for South Africa. It is a diagnostic coding standard that is accepted by all the parties as the coding standard of choice.

The ICD-10 was implemented in July 2005 under the auspice of the National ICD-10 Implementation Task Team which is a joint task team between the National Department of Health and the Council for Medical Schemes.

ICD-10 stands for International Classification of Diseases and Related Health Problems (10th revision). It is a coding system developed by the World Health Organisation (WHO), that translates the written description of medical and health information into standard codes, e.g. J03.9 is an ICD-10 code for acute tonsillitis (unspecified) and G40.9 denotes epilepsy (unspecified).

ICD-10 CLASSIFICATIONS: http://apps.who.int/classifications/icd10/browse/2010/en