Some lingo you should know
Being savvy about these 3 concepts will help you to compare different plans and their benefits.
This acronym is thrown around a lot and it stands for Prescribed Minimum Benefits. These are benefits that all medical schemes MUST cover. They include emergency medical conditions as well as 271 medical conditions and 26 chronic conditions.
Savings Vs Risk
Your plan premiums are made up of 2 parts:
1. Risk portion
This cover in-hospital expenses and PMB conditions.
2. Medical savings portion
Your medical savings (if part of your plan) are there for your day-to-day needs like visits to your GP, dentist or optometrist. Basically, this helps you to save up for medical costs, but the money is available up front. Once your medical savings are used up, you’ll need to pay for out-of-hospital expenses yourself until the beginning of the next year.
Medical Scheme Rate
If a benefit is covered at 100% of scheme rate, it means the medical aid will pay the maximum amount set for those specific treatments and procedures. BUT some providers charge MORE than 100% of scheme rate, even 200% or 300% – and then the member will have to pay the difference.
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