SchemeBookUnderstand the system. Know what to ask.
by RiskAtlas
An amount you pay yourself, on top of what the scheme pays.
Many plans require a co-payment for certain procedures or when you use a non-network provider — a fixed or percentage amount you're responsible for even though the claim is otherwise covered. PMB conditions treated at a designated service provider are generally protected from co-payments.
More jargon
Open scheme · Restricted scheme · PMB (Prescribed Minimum Benefits) · CDL (Chronic Disease List) · DTP (Diagnosis Treatment Pair) · Designated Service Provider (DSP) · Waiting period · Late-joiner penalty · Savings account / above-threshold benefit · Medical scheme · Medical aid · Medical insurance · Benefit option · Principal member · Dependant · Contribution · Underwriting · Condition-specific waiting period · Emergency medical condition · Medical savings account · Self-payment gap · Benefit limit · Scheme tariff or rate · Out-of-pocket payment · Provider network · Formulary · Generic medicine · Clinical protocol · Pre-authorisation · Managed care · Claim statement · Tariff shortfall · Claim rejection · Clinical motivation · Internal appeal · CMS complaint · Registered scheme rules