SchemeBookUnderstand the system. Know what to ask.
by RiskAtlas
The provider your scheme names as the no-extra-cost option.
A scheme can name specific hospitals, pharmacies, or doctor networks as its Designated Service Providers. Using a DSP for a PMB condition means you shouldn't face a co-payment; going outside the DSP network for a non-emergency generally means you will, unless no DSP is reasonably available.
More jargon
Open scheme · Restricted scheme · PMB (Prescribed Minimum Benefits) · CDL (Chronic Disease List) · DTP (Diagnosis Treatment Pair) · Co-payment · 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