SchemeBookUnderstand the system. Know what to ask.
by RiskAtlas
Membership is limited to a specific employer, industry, or profession.
A restricted scheme only accepts members who belong to a defined group — usually an employer, industry body, or profession (for example, a scheme for a specific bank's staff, or for civil servants). You generally cannot join one from outside that group.
More jargon
Open 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 · 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