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Abbreviations

Benefits are granted pro rata for members who join after January.

MST (Medical Scheme tariff) also called KeyHealth tariff = A tariff the Scheme pays to a service provider. Should the tariff exceed the MST, the member will be liable for the difference.

Agreed tariff = a tariff as agreed upon by the Scheme and service providers which may not necessarily be based on the NHRPL.

AD = Adult Dependant
CD = Child Dependant
PM = Principal Member
OTC = Over-The-Counter (medicine or glasses)
pbpa = per beneficiary per annum (per year)
pbp2a = per beneficiary biennially (every two years)
pfpa = per family per annum (per year)
pfp2a = per family biennially (every two years)
2pfpa = two (2) per family per annum (per year)
TTO = To-Take-Out (medicine when discharged from hospital)
   


  • Agreed tariff:
     A tariff agreed upon from time to time between the Scheme and service providers, e.g. hospital groups.

  • Angiogram:
    X-rays of the arteries.

  • Associated Network Option:
    A benefit option where groups of network providers (GPs, hospitals and pharmacies) render selected healthcare services to members at agreed upon tariffs.

  • Audiology:
    Measurement of hearing ability and correction of hearing problems.

  • Automatic Authorisation List (AAL):
     A list of chronic medication approved by the Scheme.

  • Chiropractor:
     A practitioner who treats mainly the spine through physical manipulation.

  • Chronic Disease List (CDL):
     A list of chronic illness conditions that are covered in terms of legislation.

  • Chronic medicine:
     Medication used on an ongoing basis for conditions listed in the Automatic
    Authorisation List (AAL).

  • Clinical management:
     Applying the rules for treating specific conditions as well as medical procedures.

  • Conservative dentistry:
     Basic dental services, such as fillings, extractions and oral hygiene.

  • Co-payment:
     Member’s liability payable directly to the service provider for services not covered by the Scheme in full.

  • CT and MRI Scans:
     Specialised high definition external scanning methods for internal bodily examinations.




  • Day-to-day benefit:
    A combined out-of-hospital limit which may be used by any member of the family in respect of GPs, Specialists, radiology, prescribed medicine (including a sub-limit for self-medication) and auxiliary services.

  • Dental Benefit Management Programme:
     A cost and quality dental management programme provided and managed by DENIS (Dental Information Systems).

  • Designated Service Provider (DSP):
     A service provider that renders healthcare services to members at an agreed upon tariff with the Scheme (members must make use of these services to qualify for certain benefits). This is in terms of legislation which allows the Scheme to appoint DSPs for certain chronic conditions.

  • Elective surgery:
     Non-essential (planned optional) surgery, e.g. surgery to correct a condition that is not lifethreatening and not required for survival. This includes cosmetic surgery, but excludes emergency surgery.

  • Emergency:
     An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment and/or intervention. If the treatment/ intervention is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts, or even death.

  • Generic medicine:
     A medicine with the same active ingredients as original brand-name medicines, usually at lower cost.

  • Health Booster:
     Additional health benefits for preventive care.

  • Homeopathy:
     Supplementary disease treatment using natural drugs.

  • MMAP®:
     Maximum Medical Aid Price. The maximum price the Scheme is prepared to pay for specific categories of generic medication.

  • Medical Scheme Tariff (MST):
     Also referred to as KeyHealth Tariff. A tariff the Scheme pays for services rendered by a service provider. Should the tariff charged by the service provider exceed the MST; the member will be liable for the difference.

  • National Health Reference Price List (NHRPL):
     A list of recommended medical tariffs published by the Council for Medical Schemes.

  • NAPPI code:
     National Pharmaceutical Product Interface codification used for unique medication identification.


  • Oncology:
    The treatment of cancer


  • Optical Management:
     A cost and quality Optical Management Programme provided by Opticlear.


  • Physical trauma:
    A severe bodily injury due to violence or an accident, e.g. gunshot, knife-wound, fracture or motor vehicle accident. The suffering of serious and life-threatening physical injury, potentially resulting in secondary complications such as shock, respiratory failure and death. This includes penetrating and blunt force injuries.

  • Prescribed Minimum Benefits (PMBs):
    Prescribed Minimum Benefits for specific treatments and services rendered in a State facility.

  • Preferred provider:
     A provider recommended by the Scheme that renders cost effective healthcare services to members (members make voluntarily use of these services).