Sentrix Digital · Library · Wiki
Wiki
A live index of what the Library already holds — language, glossary, traps, gaps, workflow, clinical atlas, Compass programmes, news — plus names that are referenced on the site but do not yet have their own article. It rebuilds from those sources; new terms appear here when they are added.
575 defined · 15 need definition · 590 total · showing 38
All A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
All kinds AU — Drug information (harm reduction) (21) AU — Drug information glossary (8) AU — Recognised Disabilities (Carer Allowance) (29) Claim workflow (9) Clinical atlas — condition (106) Clinical atlas — medicine (87) Confusion pair (11) Disability / incapacity (33) Dispute hub (2) Evidence gap (6) Glossary (27) Language map (20) Life insurer (85) Module (8) Needs definition (15) News (3) Ombud guidance (4) Ombud precedent (9) Policy scan (12) Policy trap (11) Rejection ground (12) SchemeBook glossary (38) Social Security Compass (37) employment-compliance (9)
B
- Benefit limit SchemeBook glossary The most an option will pay for a defined benefit in a period.
- Benefit option SchemeBook glossary The specific plan selected inside a medical scheme.
C
- CDL (Chronic Disease List) SchemeBook glossary The specific chronic conditions PMB cover extends to.
- Claim rejection SchemeBook glossary A decision not to pay all or part of a claim.
- Claim statement SchemeBook glossary The scheme's record of how it processed a claim.
- Clinical motivation SchemeBook glossary Information from a clinician explaining why care is medically necessary.
- Clinical protocol SchemeBook glossary The evidence-based steps used to decide how a condition should be treated.
- CMS complaint SchemeBook glossary A formal complaint to the Council for Medical Schemes.
- Co-payment SchemeBook glossary An amount you pay yourself, on top of what the scheme pays.
- Condition-specific waiting period SchemeBook glossary A temporary restriction on claims linked to a pre-existing condition.
- Contribution SchemeBook glossary The regular amount paid to keep membership active.
D
- Dependant SchemeBook glossary An eligible person covered under the principal membership.
- Designated Service Provider (DSP) SchemeBook glossary The provider your scheme names as the no-extra-cost option.
- DTP (Diagnosis Treatment Pair) SchemeBook glossary The government-set minimum treatment standard for a CDL condition.
E
- Emergency medical condition SchemeBook glossary A sudden condition needing immediate care to prevent serious harm.
F
- Formulary SchemeBook glossary The list of medicines a scheme approves for a benefit.
G
- Generic medicine SchemeBook glossary A medicine with the same active ingredient as an original brand product.
I
- Internal appeal SchemeBook glossary A request for the scheme to reconsider its own decision.
L
- Late-joiner penalty SchemeBook glossary A permanent extra premium loading for joining a scheme later in life.
M
- Managed care SchemeBook glossary Programmes that coordinate treatment and apply clinical funding rules.
- Medical aid SchemeBook glossary The everyday South African name commonly used for medical scheme cover.
- Medical insurance SchemeBook glossary An insurance policy that pays stated amounts for specified health events.
- Medical savings account SchemeBook glossary Part of a contribution set aside for eligible day-to-day claims.
- Medical scheme SchemeBook glossary A regulated, member-funded pool that pays healthcare benefits under registered rules.
O
- Open scheme SchemeBook glossary Anyone can join, regardless of employer.
- Out-of-pocket payment SchemeBook glossary Any healthcare cost paid by the member and not reimbursed.
P
- PMB (Prescribed Minimum Benefits) SchemeBook glossary A legally mandated minimum level of cover every scheme must provide.
- Pre-authorisation SchemeBook glossary Approval requested before planned treatment or admission.
- Principal member SchemeBook glossary The person in whose name the membership is registered.
- Provider network SchemeBook glossary A group of healthcare providers contracted for an option or benefit.
R
- Registered scheme rules SchemeBook glossary The legally registered terms governing membership and benefits.
- Restricted scheme SchemeBook glossary Membership is limited to a specific employer, industry, or profession.
S
- Savings account / above-threshold benefit SchemeBook glossary A day-to-day medical spending pot that isn't the same as your main cover.
- Scheme tariff or rate SchemeBook glossary The price level an option uses to calculate payment.
- Self-payment gap SchemeBook glossary A period when savings are finished and the member funds day-to-day costs.
T
- Tariff shortfall SchemeBook glossary The difference between the provider's charge and the scheme payment.
U
- Underwriting SchemeBook glossary The limited membership conditions a scheme may assess when someone joins.
W
- Waiting period SchemeBook glossary A window after joining where some or all benefits aren't payable yet.