Prescribed Minimum Benefits Reform Urged

Independent analysis released August 2026 warns that South Africa's Prescribed Minimum Benefits list, which defines conditions and treatments all medical schemes must cover, is outdated and no longer matches clinical reality. The result is that women are denied coverage for newer, better treatments while schemes pay inflated prices for older, less effective care, and the entire system becomes unnecessarily expensive.

Specific concerns for women's health include limited coverage for:

Modern cervical screening and treatment technologies

Newer breast cancer medications and genetic testing

Comprehensive antenatal and postpartum mental health support

Fertility preservation and family-building options

Reform is urgently recommended as part of progress toward universal health coverage under the National Health Insurance.

What this means for you

If you have medical aid, your scheme MUST cover PMB conditions but may refuse newer or better treatments. Outdated rules mean you could be paying more while receiving less effective care.

What you can do

When your scheme declines payment

• Ask: "Is this condition a Prescribed Minimum Benefit? What must the scheme cover in full?"
• Appeal decisions in writing. Many appeals succeed.
• Raise the outdated PMB framework with your political representative and the Council for Medical Schemes.

Sources

Every claim on this page is traceable. These are the documents it rests on.

1. Healthcare Update South Africa 18 August 2026