SchemeBookUnderstand the system. Know what to ask. by RiskAtlas

SchemeBook · Jargon

Condition-specific waiting period

A temporary restriction on claims linked to a pre-existing condition.

A scheme may apply up to 12 months where permitted. Previous membership history affects what may lawfully be imposed.

More jargon

Open scheme · Restricted scheme · PMB (Prescribed Minimum Benefits) · CDL (Chronic Disease List) · DTP (Diagnosis Treatment Pair) · Co-payment · 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 · 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