What you need to know
Prescribed Minimum Benefits ensure that all medical scheme members have access to essential healthcare services, no matter which option they are on.
These benefits are there to protect you when you need care the most, giving you access to treatment for serious and emergency conditions.
Under the Medical Schemes Act, all schemes must cover the costs of:
- Emergency medical conditions
- A defined list of 270 conditions
- 25 chronic conditions listed in the Chronic Diseases List (CDL)
PMBs are designed to make sure you continue to receive the care you need, without interruption.
CMS PMB ICD-10 Coded List
PMB List Of All Conditions
Prescribed Minimum Benefits (PMB) and Chronic Medication Guide.
10 Things you need to
know about PMB’s.
Access Your Benefits
Once your membership is approved, you will receive your membership card.
Your card includes your membership number, your details, your registered dependants, and the date your benefits begin.
Please keep your card safe and do not share it. Misuse of a membership card may result in your membership being suspended or terminated.
You can also access a digital version of your card on the Scheme app, or confirm your membership directly through the app when needed.
Understanding your contributions
- Download the contribution table
Click here to view the full contribution table. - Employer subsidies
The table shows total contributions before any employer subsidy.
Your payroll will confirm what portion is covered, where applicable. - Monthly payments
Contributions are collected at the end of the month for which you received benefits.
It is important to pay on time. If contributions are more than 21 days overdue, your benefits may be suspended. - Full month cover
Contributions, deductions, and benefits apply to the full calendar month.
Partial or pro-rata contributions are not available.
Using your PMSA (Savings)
Your Personal Medical Savings Account can be used for certain day-to-day healthcare costs.
- You may use available savings to pay member portions, such as the difference between Scheme rates and private rates
- This can only be done with your instruction. Payments are not made automatically
You may also apply to use savings from a previous year to cover Scheme exclusions, subject to approval by the Board of Trustees.
Please note:
- Consultation co-payments and optical costs above Scheme limits are not covered by the Scheme or the current year’s PMSA
- Your PMSA balance does not earn interest
If you leave the Scheme
If you leave Alliance-Midmed:
- Any positive PMSA balance will be paid to you after five months, once all claims have been finalised
- Please ensure your banking and contact details are up to date
If you join another medical scheme that offers a savings account, your positive balance may be transferred instead, as required by law
If your claims exceed your available savings when you leave, the outstanding amount will need to be repaid
Please note that any savings paid out to you may be subject to tax.
Important to know
- Contributions cannot be paid from your savings, as this is not allowed by law
- If you join during the year, your benefits and savings will be adjusted proportionately
For example, joining on 1 July means you will receive 50% of the annual savings amount.
Download the contribution table for quick reference!
Your membership also includes support for wellness screenings, vaccinations, and maternity care.
Protecting you through every stage of life
Vaccinations are an important part of preventative healthcare. Through the Alliance-Midmed Lifestages Benefit, members have access to a range of immunisations and vaccinations to help protect themselves and their families at different stages of life.
From childhood immunisations to annual flu protection and preventative vaccinations later in life, the programme is designed to help you stay proactive about your health.
A healthy start for little ones
Routine baby and childhood immunisations are covered according to the Department of Health recommended immunisation programme for the first 12 years of life.
Keeping your child’s vaccinations up to date helps protect them against a range of preventable illnesses.
Protection for the future
HPV vaccination can help protect against certain HPV-related diseases and cancers.
The Lifestages Benefit provides access to HPV and cervical cancer vaccinations for eligible male and female beneficiaries, subject to the Scheme’s applicable age and benefit criteria.
Who may qualify?
The Benefit Guide includes HPV vaccination for beneficiaries between 9 and 14 years, as well as specified cervical cancer vaccines for males and females between 9 and 25 years.
Protect yourself this flu season
The flu vaccine is available to all Alliance-Midmed beneficiaries once a year.
Annual vaccination is particularly important for members who may be at greater risk of developing complications from flu.
Extra protection for higher-risk members
Pneumococcal vaccination is available to members aged 60 and older, as well as members who are clinically identified as being at higher risk.
Scheme criteria, risk assessments and managed care protocols apply.
Stay protected
Tetanus vaccination is available to beneficiaries, subject to the Scheme’s managed care protocols, clinical criteria and risk assessment.
Not Sure Which Vaccinations Apply to You?
Your vaccination needs can change depending on your age, health and individual risk factors.
Speak to your healthcare provider or contact the Alliance-Midmed team for guidance on the vaccinations available to you and any Scheme requirements that may apply.
Convenient care without a hospital visit
To make treatment more accessible and affordable, certain minor procedures can be done in your doctor’s rooms instead of a hospital.
This means quicker care, lower costs, and added privacy.
The Scheme pays doctors an enhanced rate for these approved procedures.
What is covered
These include selected minor procedures such as:
- Treatment of minor wounds and stitching
- Laceration and scar repair
- Removal of foreign objects
- Deep skin biopsies with suturing
- Needle biopsies
- Treatment of bursae and ganglia
- Chemo-cryotherapy
- Nail bed repair
- Male circumcision performed in GP rooms
What this means for you
Where appropriate, your doctor may treat you in their rooms instead of referring you to a hospital.
This helps reduce costs and makes your care more convenient.
Minor In-Room Surgical Procedure Rates
We’re here to help!
Our Call Centre Support Team is available Monday to Friday 07:30 – 16:30.
If you contact us after hours, we’ll respond as soon as possible.
24-Hour Medical Emergency
0860 255426 (0860 ALLIANCE)
- Always present your membership card when receiving medical care
- Medical professionals are required to assist
in emergencies - Alliance-Midmed is a medical scheme,
not insurance
Scheme Call Centre
CALL: 0860 002 101
Hours: 07:30 – 16:30, Monday to Friday
After-hours membership confirmation is available on the same number.
For general queries after hours, please use the Member App or website.