Benefit for PMB cover rejected

I am responding to the correspondence dated the 31st of August 2026 as I realise the rejection to cover the pregnancy was based on admission to the hospital.

The council of the Medical scheme rules states that PMB must be covered whether in or out of Hospital. I have previously added screenshots about this from the rules.

Further I would like to understand the meaning of Necitating hospital and including delivery because in my understanding it means that the treatments of antenatal and obstetrics care leading the patient to be admitted and delivery in the future. For me the definition of "necitating" does not mean cover only in hospital, I would like the legal definition for the treatment under the code 52N to be fully detailed for me to accept the rejection of my pregnancy being declined as a PMB condition because the medical scheme seems to also be missing the rule that state that PMB MUST Be covered regardless of which medical aid option is taken.

Your detailed response in addressing the above will be highly appreciated.