Many words that are unknown to the public are used in the healthcare industry. This can cause misunderstandings between members and schemes about what really is included in a medical aid package, which can be avoided altogether if the definitions of these terms are more accessible.
Why do some medical scheme providers fail to explain the exact meaning of jargon like “late joiner penalties” or “waiting periods”? Not all schemes are transparent and do not inform customers of what it really is that they’re signing up for when they join a scheme. KeyHealth is different and makes information about all of these must-know phrases freely available.
Terminology to Know before Getting Medical Aid
Though there is no reason to become an expert in the field and to understand every industry-related term in 2022, it is worth knowing the basics to ensure that you are fully aware of what your preferred scheme option entails.
Below are eleven widely used medical aid terms that South Africans should know when researching and comparing health plans:
- Premium – The cost of having your medical aid, which is billed monthly and can be found at any of the KeyHealth cover option pages under ‘‘2022 monthly contributions’’.
- Dependants – Those who also benefit from your membership package and for which a lower membership fee applies than for you as the principal member. Child dependants are persons younger than 21 years and adult dependants include anyone over that age. Different premiums are payable depending on the applicable dependant category.
- Benefits – In any medical aid option, you’ll find a list of benefits. These can be pharmaceutical, treatments and procedures relating to your health. Each benefit can have a set amount allocated to it or be labelled as unlimited.
- Late Joiner Fees or Penalties – A penalty that can occur when a new member of the scheme has never had health cover before or hasn’t had medical aid for quite some time. This can only be charged to those over a certain age and the fee may differ from person to person, depending on how many years you’ve not had cover as an adult.
- Waiting Periods – A set time in which you cannot claim any benefits from the scheme. These can be imposed when joining after not having cover for at least 90 days for a period of twelve months on pre-existing conditions. Anyone new to a scheme can also be told to wait three months before claiming.
- Pre-Existing Conditions – Prior injuries or health-related issues that are present when you take out a medical aid package.
- Chronic Conditions – Illnesses that last for more than 90 days and can cause the death of an individual without regular treatment and medications. In South Africa, there’s a chronic disease list or CDL, which presents a variety of serious conditions that all medical aids have to cover regardless of the premium or package taken out.
- PMBs – These are the prescribed minimum benefits, that, according to the Medical Schemes Act, must be included in your cover. 271 Health conditions are included in this list for which members can get treatment, diagnosis and medication, regardless of their monthly premium. The CDL falls under this and consists of 26 conditions. It’s important to note that schemes do have some customisation options for the way the benefit is applied, such as limiting members to using DSPs.
- Designated Service Providers – Also known as DSPs, these are the healthcare professionals that a scheme chooses to associate with and have agreements on prices for certain procedures and treatments.
- Specialist Services – These refer to medical procedures and treatments, which are only available from a healthcare professional who has expertise in treating specific conditions and focuses on a particular field of care in the healthcare service offering.
- Exclusions – Exclusions are the services that are not included in your health plan. Typically, a cheaper medical aid will not cover any dentistry work or cosmetic services. Health insurance providers can also have a set list of instances where they won’t cover the cost of healthcare, such as persons deliberately causing injury to themselves.
Sign Up at KeyHealth and Get Informed
If you’re still in the market for a superior healthcare plan in 2022, consider joining a scheme you can trust. At KeyHealth, our representatives are eager to explain to potential members what KeyHealth’s options entail. This is to ensure you know what you’re signing up for and avoid any uncertainty when you make your decision
Choose a medical aid option at KeyHealth, and you can rest assured knowing that you’re covered for the future.
