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The 270 PMB Conditions Listed

In South Africa, all registered medical aid schemes are legally obligated to cover the diagnosis, treatment, and care of a defined list of medical conditions known as the Prescribed Minimum Benefits (PMBs).

This list includes approximately 270 Diagnosis and Treatment Pairs (DTPs) grouped by body system, ensuring members have access to essential healthcare services irrespective of their chosen plan.

PMBs include emergency conditions, life‑threatening illnesses, and serious injuries that could otherwise impose catastrophic costs on patients. To make the list easier to navigate, we’ve organised the 270 conditions into collapsible categories below. This gives you a clear picture of what is covered and why it matters.

How to Use This List

Each category below contains representative PMB conditions and their typical treatment approach. Click to expand and view the conditions legally required to be covered by all medical schemes. These cover both hospital and out‑of-hospital treatment where clinically appropriate.

Brain & Nervous System
  • Acute generalised paralysis (e.g., Guillain‑Barre) – Medical management, ventilation, plasmapheresis
  • Benign and malignant brain tumours – Medical and surgical management, chemo/radiotherapy
  • Compound/depressed skull fractures – Craniotomy/craniectomy
  • Peripheral nerve injuries – Neuroplasty and repair
Respiratory System
  • Pneumonia (bacterial, viral, fungal) – Medical management and ventilation
  • Acute asthmatic attack – Immediate medical management
  • Adult respiratory distress syndrome – Medical management, oxygen therapy
  • Chest trauma with life‑threatening complications – Surgical and supportive care
Heart & Circulation
  • Heart attacks – Emergency surgical and medical management
  • Aortic aneurysm rupture – Urgent surgical repair
  • Peripheral arterial disease with gangrene – Surgical intervention and possible amputation
  • Coronary artery disease – Surgical bypass and medical management
Gastro‑Intestinal System
  • Appendicitis – Appendectomy and medical management
  • Life‑threatening gastrointestinal bleeding – Surgery and stabilisation
  • Hernia with obstruction – Surgical repair
  • Portal vein thrombosis – Shunt or surgical care
Musculoskeletal & Trauma
  • Closed fractures and dislocations – Reduction and relocation
  • Crush injuries to limbs – Surgical management
  • Osteomyelitis – Medical and surgical treatment
  • Cellulitis with septic risk – Urgent medical care
Ear, Nose & Throat
  • Acute mastoiditis – Mastoidectomy and treatment
  • Epistaxis not controlled by packing – Cautery and repair
  • Foreign body obstruction – Removal and medical care
  • Treatable cancers of head & neck – Surgery and chemo/radiotherapy
Eye Conditions
  • Glaucoma complications – Surgery or laser treatment
  • Cataract with visual impairment – Extraction and lens implant
  • Retinal detachment – Surgical repair
  • Traumatic eye injuries – Surgical management
Systemic & Infectious Diseases
  • HIV infection – Antiretroviral therapy and monitoring
  • Tuberculosis – Diagnosis and treatment
  • Syphilis (all stages) – Medical management
  • Sepsis and systemic infections – Urgent medical intervention

Note: These examples represent major PMB groups. The full list includes approximately 270 individual Diagnosis and Treatment Pairs, covering surgical, medical, and emergency conditions that medical schemes must fund.

Why Knowing the 270 Conditions Matters

Medical schemes cannot limit or exclude PMB conditions, even if your regular annual benefits have been used up. PMBs protect members against catastrophic medical costs by ensuring full cover for serious illnesses and emergencies, provided treatment follows medical scheme protocols and, where required, uses Designated Service Providers (DSPs).

Understanding which conditions are on the PMB list helps you and your healthcare provider prepare documentation and ICD‑10 codes correctly, ensuring claims are paid from the correct benefit pool rather than from savings or out‑of‑pocket expenses.

Frequently Asked Questions

What are the 270 PMB conditions?

They are a defined list of serious medical diagnoses linked to specific treatments that all registered medical schemes in South Africa must cover. This list is known as Diagnosis and Treatment Pairs (DTPs).

Are PMB conditions the same as chronic conditions?

No. PMBs include acute, chronic, and emergency conditions. The Chronic Disease List (CDL) is a subset within the PMB list covering long-term illnesses like diabetes and asthma.

Can I use any doctor for PMB treatment?

Emergency treatment can be received anywhere, but for planned care, you may need to use a Designated Service Provider (DSP) to ensure full benefit without co-payments.

Does every medical plan cover PMBs?

Yes. All registered medical aid plans must provide full cover for PMB conditions under South African law.

Can PMBs be paid from my savings account?

No. PMBs must be paid from risk benefits, not your medical savings account, to ensure full coverage.

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