Terminology Used in South African Medical Aid Quotes
More often than not people struggle in making comparisons between South African medical aid quotes because of the terminology used in the profession. We explain some of the terminology to help you understand the wording in the South African medical aid quotes and thus make it easier to compare various Schemes and benefits packages.
Agreed Tariff
It is the amount payable for a specific service or product as agreed upon between the Scheme and the service providers. The tariff is revised from time to time.
Day-to-day Benefits
It refers to the benefits payable for out-of-hospital services. Note that it refers to the combined out-of-hospital limit to which the member is entitled for services and medication with regard to General Practitioners, pathology, prescribed medicine, specialists, optical, dental and auxiliary medical services. The day-to-day benefit also includes self-medication according to the terms and conditions and tariff limits as set out in the pricing structure of the Scheme.
Elective Surgery
In South African medical quotes it refers to non-essential and or planned optional surgery to treat non-life threatening conditions. Examples of elective surgery include that of cosmetic surgery and cosmetic dentistry. It excludes emergency surgery.
Designated Serviced Provided (DSP)
It refers to appointed or allowable medical service providers and services to members according to the agreed tariff between the Scheme and the DSP. Such services and the service provider must be used by the member to qualify for stipulated benefits.
Chronic Disease List (CDL)
It refers to the list of chronic conditions which must be covered by a medical aid provider in terms of South African legislation.
Emergency
An emergency medical condition refers to an injury or health condition that is sudden and which must be treated immediately to prevent death or serious long term health problems such as organ damage or severe weakening of the body.
Over-the-Counter (OTC) Medication
Medication that can be bought over the counter at a pharmacy and for which a prescription is not needed qualifies as OTC. It also includes glasses.
Medical Scheme Tariff (MST)
MST refers to the set of tariffs that the particular Scheme such as KeyHealth is willing to pay for the rendering of services by approved service providers.
To-Take-Out Medicine (TTO)
TTO refers to the medicine that has been prescribed to the patient in the hospital for taking with when being discharged from the hospital.
Dental Information Systems (DENIS)
DENIS refers to the contracted service providers for the management of dental benefits on behalf of the specific medical aid scheme, according to specific protocols and quotes.
Optical Management
In terms of KeyHealth quotes it refers to the quality and cost of optimal management as provided by Opticlear.
Medical Savings Account (MSA)
The MSA is the member’s out-of-hospital beneficiary account from which day-to-day benefits are paid.
Physical Trauma
It refers to any serious bodily injury sustained in an accident or because of violence. Such an injury is life threatening and can lead to further complications such as shock or heart failure and eventually death.
Considerations
When comparing South African medical aid quotes consider whether such include day-to-day benefits, hospital plans and preventative care. Also remember that the quotes are normally for one member only and you need to stipulate how many beneficiaries should be included in the quotes.
It is furthermore essential to compare benefits packages which are on the same level if you compare two medical aid schemes. When comparing the various packages available from KeyHealth also keep your monthly budget in mind. If you are unable to afford for instance, the Gold package rather opt for a less comprehensive package with lower pay-out limits as this will also mean lower monthly contributions.
In a day and age when violence, vehicle accidents, chronic diseases, and crime are on the increase, it is essential to be pro-active in securing optimal medical care and financial security. Belonging to a reputable medical scheme that includes hospital plans will help you do just that. Without such you will need to pay for expensive treatments in cash and also emergency services and may end up with tremendous medical debt after a vehicle accident.
We want you to make an informed decision regarding the best option for you and your family and such offer objective guidance regarding the services and products that we offer. Take the responsible step for your future. Invest in medical aid.
