SchemeBookUnderstand the system. Know what to ask.
by RiskAtlas
A day-to-day medical spending pot that isn't the same as your main cover.
Many plans allocate part of your premium to a personal medical savings account for day-to-day claims (GP visits, over-the-counter medicine). Once that's exhausted, some plans have an above-threshold benefit that kicks back in — but there's often a gap in between where you pay out of pocket.
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 · 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