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Jargon Explained

DSP: Designated Service Provider (DSP) is a healthcare provider (doctor, pharmacist, hospital, etc) that is a medical scheme’s first choice when its members need diagnosis, treatment or care for a PMB condition. Could be a State facility.

Formulary: List of approved medicines for each condition. Each scheme has its own formulary which determines how it pays for medication. Some schemes have different lists (formularies) for different plans. If the medication you need is not on the formulary, the scheme might not pay for it, or might ask you for a co-payment.

Network Provider: A healthcare service provider (doctor, pharmacy, hospital, optometrist etc) with whom the scheme has a payment or service arrangement. Your plan might limit you to only providers in the network, or might require you to make a co-payment if your provider is not part of the network. Often, if you use network providers, the scheme will cover the cost in full, but check your plan for details.

PMB: Prescribed Minimum Benefits, is a set of conditions and their treatments that every plan must cover, in and out of hospital, regardless of what plan you are on, how much money (if any) is in your medical savings account etc. There are 270 recognised PMBs, including all emergency (life threatening) conditions and 27 chronic conditions. We have a more detailed explanation on PMBs here.

Scheme Rate: 100% is pre-set amount that the Scheme will pay for a service. If they pay at 200%, it means they will pay double what they normally would. You or your gap cover must pay the difference, if any. strong>There is no public reference as to what each Scheme pays out for what service.

More Jargon explained here

Medical Cover 101

Pregnancy cover if you don’t have medical aid

May 5, 2017

All about PMBs, and how schemes have to pay for them

Jan 17, 2017

rehealth.co.za has a simple purpose: to help you choose the best healthcare cover for your needs and your budget. We do this by comparing apples to apples, explaining the jargon and generally adding transparency to the whole complicated process!

Rehealth.co.za wants you to have all the cover that you need, at minimum price. Achieving this is no easy task, and requires a clear understanding of all plans on offer, as well as how the medical aid / insurance law works in your favour (or against you). We then take that knowledge, and combine it with your risk profile and your expectation of future medical cover needs. We mix products that complement each other, and ultimately, we are quite confident we will save you money. And we don’t charge you a cent.

We partner with AskAdam and Argentum (FSP:45036) to provide brokerage services to clients who require one-on-one advice, both individual and corporate for their health and other insurance need. Argentum is an authorised financial service provider.

You can contact us anytime for help with your cover!

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Medical Cover 101

Pregnancy cover if you don’t have medical aid

How to use this site

All about PMBs, and how schemes have to pay for them

How medical aids work