BEL ONS: 012 644 4300
WELLNESS IS A WAY OF LIFE
that entails self-responsibility, balance and personal
development in all dimensions of your life.

Make a stand for your health!


By Dr Eugene Brink Much has been said about the pernicious effects that sitting has on our lives. Sitting for long periods at work is indeed something we need to avoid and lessen for us to stay healthy. It is recommended that we run and walk more to counteract the...

Lees meer >

THIS IS WHERE TO GO WHEN YOU
WANT TO LOOK AFTER YOUR HEALTH
Your personal wellness is important to us. If you’re not sure about your medical cover
or perhaps you want to compare tariffs, if you want to find out more about gap cover,
need reliable advice or a support group, or if you are grappling
with a difficult medical term, then this is the right place for you to be.

MEDICAL SCHEMES

Medical coverage – a necessity we don’t always realise the worth of until the day we need it and we are also constantly uncertain whether we have chosen the right option and scheme.

The various medical aids and options are overwhelming and without expert advice, choosing the best medical aid and product can be a time consuming and complicated process.

Solidarity World simplifies the choice by giving you

a short explanation
on the type of medical cover which is available.
a comparison
of tariffs.
additional products
to fill shortcomings in your medical product.
access to free advice
for Solidarity World visitors by an accredited advisor.

Get free medical scheme advice
Medical schemes comparison

Behoeftebepaler 2018 Engels
MY DETAILS
MEDICAL NEEDS DETERMINER
NoYes
NoYes
NoYes

GAP COVER ADVICE


An essential complementary product – gap cover

Although medical schemes offer peace of mind in the knowledge that you have access to medical services medical aid does not necessarily pay for all medical services in full. For example, the rates certain specialists charge for procedures are significantly higher than medical aid rates for those procedures. Moreover, medical schemes require excess payment in respect of certain procedures performed in hospital. If you don’t have a gap cover product you will have to cough up the difference which may well amount to several thousand rand.

What is gap cover?

You have to be a member of a registered medical scheme to take out gap cover.
It can cost as little as R252 per month depending on your profile and the option you choose. If your employer agrees to take out group gap cover it may cost even less.
Gap cover mainly covers short payment and excess payments in respect of in hospital procedures.
Certain gap cover products of also offer additional cover in case of a life-threatening disease such as cancer.
my details

Gapcover 2018

ADVICE SERVICES


Get reliable advice

Choosing a medical fund or gap cover product, or changing from insurer or scheme, is a laborious and complex process with various rules and conditions that apply. An accredited advisor can help you make the process painless, at no additional cost.

Solidarity has appointed Tendahealth to provide medical and related services to members of the Solidarity Movement. By appointing Tendahealth as your advisor, you will therefore have free access to these services. Tendahealth has concluded an agreement with Solidarity, according to which a portion of the regulated commission paid to Tendahealth is backed up by medical schemes in the Movement.

Fill out the form below to get the services and an adviser will contact you.

my details

Advies 2018


Contact Tendahealth representative:
Mosefe Masemola
082 509 1115
mmaselola@mosefe.co.za

If we are unable to resolve the complaint, it may be referred to the FAIS Short-Term Insurance Ombudsman.

Disclaimer

remember: Accredited advice

Advisors must comply with several legal requirements before they can provide advice. These include formal examinations in insurance laws that they must pass and further training in financial services they must complete. In order to offer a medical scheme's products, an advisor must also have a formal agreement with the scheme in place and also undergo product training. Advisers are also obliged to offer all available options to customers and to provide terms and conditions, which will allow customers to make informed decisions. Customers do not pay for these services. The medical scheme does pay commission to the new business adviser. This commission is therefore regulated.
tenda health declaration

Tendahealth (Edms.) Bpk., Reg. No. 2012/105834/07
Tendahealth is an authorized financial services provider (FSP No. 44680)
RMS-accreditation: ORG.4268


Compensation:
Tendahealth earns commission subject to the provisions of the Medical Schemes Act, No. 131 of 1998, and the Short-term Insurance Act, No. 53 of 1998.

Complaints:
Tendahealth has a process available on our website or via enquiries@tendaonline.co.za. Do not hesitate to contact us if you have any questions.

SUPPORT GROUPS

Support groups are there to provide a network of support in the areas of your life where you feel the need for advice or encouragement. In most cases, support groups consist of a group of people with shared experiences or concerns, and they encourage each other by providing the necessary support to overcome specific obstacles. The five available support groups are listed below:

YOUR A - Z OFF WELLNESS

We realise that some medical terms and conditions are complex and that one does not always understand everything the doctor tells you. For explanations of medical terms, diseases, conditions and medication, click here. We speak your language.

ABCDEFGHILMNOPRSTUV
Acute medicine

Acute medicine

Acute medication is used to treat acute diseases, which are diseases characterised by rapid onset and are short in duration. Examples of acute diseases include pneumonia, meningitis, smallpox or measles.

Acellular pertussis

Acellular pertussis

Pertussis is more commonly known as whooping cough. The acellular pertussis vaccine is a combined diphtheria, tetanus and pertussis vaccine containing one or more antigens (a substance which induces a specific immune response) but no whole cells. This causes fewer adverse reactions than vaccines containing whole cells.

Adenoidectomy

Adenoidectomy

Surgical removal of the adenoids. Adenoids are also known as pharyngeal tonsils and are small lumps of tissue at the back of the throat, above the tonsils. They protect the body from harmful bacteria and viruses, particularly in babies and young children.

Anaphylaxis

Anaphylaxis

A life-threatening type of allergic reaction which develops quickly, often in reaction to drugs, food or insect bites. Symptoms include hives; breathing difficulties; swelling of the face, eyes or tongue; and nausea or vomiting.

Apisectomy

Apisectomy

The surgical removal of a dental root apex.

Application date

Application date

The actual date on which the scheme receives an application for membership or registration of a dependant.

Aptitude

Aptitude

Ability to acquire a skill

Asthma

Asthma

Asthma is a lung disorder characterised by narrowing of the bronchial airways resulting from inflammation of the airway lining. This swelling and accumulation of mucous and spasm of the muscles (bronchospasm) leads to shortness of breath/difficulty breathing, wheezing, coughing and congestion. Bronchial asthma can be caused by a wide range of irritants such as allergens, emotion, exercise, medicine, climate changes, air pollution or infection, and can be treated

Dependant of a member

Dependant of a member

Means the spouse or partner as well as the dependent children, father, mother, brothers, sisters and grandchildren of the member in respect of whom the member is liable for family care and support, and who is not a member or a dependant of a member of another medical scheme. For the purpose of applying this definition, the following shall mean:

    • “Dependent child” means a child who is not self-supporting and in respect of whom the member is liable for family care and support. For the purpose of applying this definition, child means –
      • (a)(i) the natural child of a member; or
      • (a)(ii) a stepchild; or
      • (a)(iii) an adopted child or a child in the process of being adopted and who has been placed in the custody of the member, as defined in section 1 of the Children’s Act, 2005 (Act No 38 of 2005); or
      • (a)(iv) a foster child or a child in the process of being placed in foster care and who has been placed in the custody of the member, as defined in the Children’s Act, 2005 (Act No 38 of 2005); or
      • (a)(v) a child born in terms of a surrogate motherhood agreement with a member confirmed by the High Court, as defined in the Children’s Act, 2005 (Act No 38 of 2005); or
      • (a)(vi) a child, being cared for by the member, in temporary safe care as defined in the Children’s Act, 2005 (Act No 38 of 2005); or
      • (a)(vii) a child, as defined in (i) to (vi) above, of a member’s partner.

 

      • “Family care and support”, means, with regard to the dependant of a member, the financial care by a member of a dependant who is not selfsupporting.

 

      • “Partner” means a person of the same or opposite gender within a relationship of a dedicated and permanent nature with the member that is comparable to a marriage based on objective criteria of mutual dependence, and who shares a common household with the member.

 

    • “Spouse” means a person of the opposite gender within a marriage solemnised in accordance with any Act or custom.
Bacilles Calmette Guerin

Bacilles Calmette Guerin

A vaccine against tuberculosis (TB) prepared from a stain of weakened live bovine (cow) tuberculosis bacillus.

Bipolar mood disorder

Bipolar mood disorder

An affective disorder characterised by the occurrence of alternating periods of euphoria (mania) and depression.

Bipolar mood disorder is a common mental disorder, and is characterised by disturbances in physical, emotional and behavioural patterns.  These mood patterns can range from great elation and agitation to extreme depression with a serious potential for suicide. These extreme shifts in energy, mood, and functioning can seriously affect the person’s ability to function in their normal activities of daily living, such as work, interacting with friends and family, sleeping and eating. These mood fluctuations occur in phases and are known as manic episodes, depressed episodes, and mixed episodes (both depressed and manic).  The condition can be managed by taking specific medicine and psychotherapy.

Bone augmentation

Bone augmentation

Bone enlargement

Breast augmentation

Breast augmentation

Breast enlargement.

Bronchiectasis

Bronchiectasis

The chronic dilation of the bronchi or bronchioles as a sequel of inflammatory disease or obstruction.

Bruxism

Bruxism

Tooth grinding.

Chronic medicine

Chronic medicine

Chronic medicine is medicine used for the long-term treatment (three months or longer) of a chronic condition, and which meets the following requirements:

  • It must be used to prevent or treat a serious medical condition;
  • It must be used for an uninterrupted period of three months or longer;
  • It must be used to sustain life, to delay the progress of a disease, and to repair natural physiology;
  • It must be registered in South Africa for the treatment of the medical condition for which it is prescribed; and
  • It must be the accepted treatment according to local and international treatment protocols and algorithms.
Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD)

A general term used for those diseases that permanently or temporarily narrow the small bronchi, in which forced expiratory flow is slowed, especially when no etiologic or other more specific term apply.

 

Chronic renal disease

Chronic renal disease

Chronic disease of the kidneys.

Crohn’s disease

Crohn’s disease

Regional enteritis; a chronic enteritis of unknown cause, involving the terminal ileum and less frequently other parts of the gastrointestinal tract

 

Day-to-day benefit

Day-to-day benefit

Benefits covering the everyday services offered by your general practitioner

DBC

DBC

A non-surgical back treatment intervention programme in lieu of surgery for the management of spinal column disease/conditions/ abnormalities. This new approach to the treatment of back and neck pain is used as an alternative to back surgery, and involves an interdisciplinary team handling the rehabilitation programme, which is individualised for each patient based on the patient’s needs and clinical diagnosis.

 

Debit order request for deduction of arrears subscription fees

Debit order request for deduction of arrears subscription fees

A one-off debit order request to spare you the trouble of making online payment or visiting your bank.

Dental Information Systems (Denis)

Dental Information Systems (Denis)

South Africa’s leading dental benefit management company.

Dentectomy

Dentectomy

The surgical removal of all remaining teeth.

Diabetes insipidus

Diabetes insipidus

Chronic excretion of very large amounts of pale urine of low specific gravity, causing dehydration and extreme thirst. It ordinarily results from the inadequate output of the pituitary antidiuretic hormone.

 

Diabetes mellitus

Diabetes mellitus

A metabolic disease in which carbohydrate utilization is reduced and that of lipid and protein enhanced; it is caused by an absolute or relative deficiency of insulin.

Diabetes mellitus is a disorder of carbohydrate metabolism in which sugars in the body are not oxidised to produce energy due to a lack of the pancreatic hormone insulin. The accumulation of sugar in the blood (hyperglycaemia) leads to its appearance in the urine. Symptoms include thirst, weight loss, and the excessive production of urine – waking up at night due to thirst, excessive cravings or frequent passing of urine should alert people to investigate the possibility of diabetes. If left untreated the use of fats as an alternative source of energy leads to disturbances in the acid-base balance, the accumulation of ketones in the bloodstream (ketosis) and eventually diabetic coma.

Diabetes that starts in childhood or early adolescence is usually more severe than that beginning in middle or old age. It is known as type 1 diabetes mellitus as patients have very little or no ability to produce the hormone and are dependent on insulin injections. In type 2 diabetes mellitus, which usually occurs in after the age of 40 but may develop in younger people, the pancreas retains some ability to produce insulin but this is inadequate for the body’s needs, or alternatively the body becomes resistant to the effects of insulin. Control of the diet is crucial in all types of diabetes, with adequate carbohydrates, as a lack of balance in the diet or insulin taken leads to hypoglycaemia. Long-term complications of diabetes include damage to blood vessels, and it can affect the eyes, nerves and kidneys.

Diphtheria

Diphtheria

Upper respiratory tract illness caused by Corynebacterium diptheriae (a bacteria), which causes swelling of the neck and makes breathing difficult. Other symptoms include fever and sore throat.

Dysrhythmia

Dysrhythmia

Defective rhythm.

Dysrythmias

Dysrythmias

Cardiac dysrhythmia (also known as arrhythmia) is a term for a variety of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular.

Some dysrhythmias are life-threatening medical emergencies and can result in cardiac arrest. Others cause symptoms such as an abnormal awareness of heart beat (palpitations), and may be caused by atrial/ventricular fibrillation, conduction defects, and other technical or mechanical issues in cardiac pacemakers/defibrillators. Still others may not be associated with any symptoms at all, but may predispose the patient to potentially life threatening stroke or embolism.

 

Edema

Edema

(Spelled ‘Oedema’ in British & SA English and ‘Edema’ in American English)

Oedema, commonly known as Dropsy, is the medical term for fluid retention. The build-up of fluid in the body causes swelling and can result in kidney or heart failure.

Electrognatography

Electrognatography

An advanced diagnostic tool.

Endometrial ablation

Endometrial ablation

A medical procedure which ablates (destroys) the endometrial lining of the uterus. It’s used to treat heavy bleeding and is only carried out once hormonal and other medical therapies have been unable to address the problem.

Endoscopic procedures

Endoscopic procedures

An endoscopy is a procedure in which a doctor is able to look inside a human body to examine organs and tissues with a device called an endoscope.

Epilation

Epilation

The removal of hair.

Epilepsy

Epilepsy

A chronic disorder characterised by paroxysmal brain dysfunction due to excessive neuron discharge, and usually associated with some alteration of consciousness.

Epilepsy is a neurological disorder or brain function disorder characterized by recurrent seizures that have a sudden onset. In different patients these may range from dramatic convulsive seizures, to “absence” seizures that take the form of brief lapses in awareness “blanking out” during which the posture and balance are maintained. Treatment can control the epilepsy.

EVARS prostheses

EVARS prostheses

EVARS prostheses shall only be considered where the patient suffers from an abdominal aortic aneurysm with an accompanying high risk for anaesthesia.

Co-payments

Co-payments

Co-payments are the difference between the cover provided by your Medical Scheme and the cost/tariff charged for the medical service, and are payable directly to the service provider. Members must make co-payments in the following cases:

  • When doctors and other providers of medical services charge fees which exceed you Medical Scheme’s contracted/ scheme tariff, the member is responsible to pay the difference between the amount charged and the amount which the medical scheme pays.
  • When your Medical Scheme benefit allocation is not 100% (e.g. for acute medicine), or where the cost exceeds the limit available for the service (e.g. for medical, surgical and orthopaedic appliances);
  • When the member chooses not to obtain services from a designated service provider (e.g. the SAOC network in the case of oncology); or
  • When a pre-determined co-payment is applicable to a specific benefit as indicated per benefit option
Formulary

Formulary

A formulary is a scientifically compiled list of high-quality, cost-effective non-chronic (acute) and chronic medications that are covered in a specific benefit option. A formulary can be based on the active ingredients of the medicine or relate to specific trade names.

Fluorosis

Fluorosis

A condition due to the excessive intake of fluoride.

Frenectomy

Frenectomy

The surgical removal of a frenum or fold.

Gap cover

Gap cover

When healthcare practitioners charge in excess of medical aid rates, particularly during hospitalization, there’s a shortfall between their fees and what medical aid will cover. You can take out gap cover (insurance) to cover this shortfall.

Gastroplasty

Gastroplasty

The surgical treatment of a defect to the stomach or lower oesophagus by using the stomach wall for reconstruction.

Gingivectomy

Gingivectomy

The surgical removal of unsupported gum tissue.

Glaucoma

Glaucoma

A disease of the eye characterised by increased intraocular pressure and excavation and atrophy of the optic nerve.

Glaucoma is an eye disorder causing visual loss due to the abnormally high pressure inside the eye due to too much liquid (known as aqueous humour) in the eyeball, causing damage to the optic nerve at the back of the eye.  This damage can lead to loss of peripheral vision, and eventually to blindness if left untreated.

Contracted tariff

Contracted tariff

Contracted tariff is the tariff as approved by the Board of Trustees and contractually agreed with service providers, which includes per diem, fixed and global fees.

Haemophilia

Haemophilia

An inherited disorder of blood coagulation characterised by a permanent tendency to haemorrhages, spontaneous or traumatic, due to a defect in the blood coagulating mechanism.

Haemophilus influenza

Haemophilus influenza

Haemophilus influenzae type b (or Hib), is a bacterium which causes meningitis and pneumonia. Unlike the name suggests, it does not cause influenza.

Health and benefit booster

Health and benefit booster

The health and benefit booster offers benefits for preventative care by means of risk assessment tests, to ensure the early detection of expensive medical conditions in particular, or to assist with the effective management thereof.

Health-essential functional prostheses

Health-essential functional prostheses

Health-essential functional prostheses necessarily replace a part of the body or a component thereof, or perform an essential function of the body.

Health tests

Health tests

Health tests are risk assessment tests to determine whether a person may have a disease or the risk of developing a disease, most Medical Schemes covers the following tests as part of its preventative care benefits.

  • Pap smear – pathology

 

  • Blood sugar test

 

  • Cholesterol test

 

  • Standard mammogram

 

  • Prostate test

 

  • HIV rapid test
HIV/AIDS

HIV/AIDS

HIV stands for Human Immunodeficiency Virus. HIV slowly weakens a person’s immune system, and therefore a person’s ability to fight off other diseases, by destroying CD4+T cells. HIV can lead to Acquired Immune Deficiency Syndrome (AIDS), a group of serious sicknesses which can only occur when the immune system is very weak.

HIV rapid testing

HIV rapid testing

HIV rapid testing should take place in a controlled clinical environment to determine HIV-status and should include pre- and post-testing counselling. This test may be followed by pathology tests according to Scheme protocols.

Hospice services

Hospice services

A service rendered to patients who are terminally ill to make their last days as comfortable as possible – especially cancer patients.

Hospital benefits

Hospital benefits

Refer to benefits for services rendered by a hospital during a patient’s stay in hospital. Services include ward accommodation and ward medicine, general radiology and pathology, physiotherapy and other supplementary services rendered during hospitalisation. Hospital benefits are subject to pre-registration and a 10% co-payment will be applicable to the hospital account if the admission is not pre-registered. Emergency admissions must be registered on the first workday following the admission (see also “emergency medical condition”).

Hospital plan

Hospital plan

A plan which covers accounts that are submitted by service providers only while you are hospitalized. You are responsible for your own day-to-day doctors’ expenses. They cost less than comprehensive medical aid plans.

Hymenectomy

Hymenectomy

Hymenectomy (hymenotomy) is a minor medical procedure involving the surgical removal or opening of the hymen (the layer over the vagina).

Hyperlipidaemia

Hyperlipidaemia

The presence of abnormally high concentrations of lipids in the circulating blood.

Hypertension

Hypertension

Hypertension or high blood pressure is the elevation of the arterial blood pressure above the normal range expected in a certain age group. The cause of hypertension is unknown, but may be attributed to genetic factors, underlying disease such as kidney disease, endocrine diseases or disease of the arteries, or lifestyle (including obesity/lack of exercise). It often presents no symptoms, but may cause headaches and dizziness. It is important to have your blood pressure checked regularly, because it may cause damage to tissues and organs, heart disease, hardening of the arteries and even stroke if left untreated. Normal blood pressure is around 120/80, and the hypertension guidelines recommend initiating treatment when your blood pressure remains above 140/90.

Hypothyroidism

Hypothyroidism

Hypothyroidism is the subnormal activity or functioning of the thyroid gland. If present at birth and left untreated it may lead to cretinism, which may cause mental and physical slowing in adults, undue sensitivity to cold, slowing of the pulse rate, weight gain and coarsening of the skin (myxoedenia), while also impacting on general metabolism.

Hyperlipidaemia (high cholesterol)

Hyperlipidaemia (high cholesterol)

Hyperlipidaemia or “elevated cholesterol” is a condition which occurs when there are elevated levels of cholesterol (hypercholesterolaemia) and/or triglycerides (hypertriglyceridaemia) in the blood. This condition, left untreated, may predispose a person to coronary heart disease and the development of fatty plaques on the inner walls of arteries (atherosclerosis), with eventual restriction of blood flow. Familial hypercholesterolaemia is a common cause of this condition.

Hypothyroidism

Hypothyroidism

Diminished production of the thyroid hormone.

Hysterosalpinogram

Hysterosalpinogram

Radiography of the uterus and uterine tubes after an opaque fluid has been injected.

 

ICD-10 code(s)

ICD-10 code(s)

The attending doctor will be able to provide you with these codes.

ICON -add

Immunisations

Immunisations

Standard immunisations are child immunisations in accordance with the guidelines set by the Department of Health on the standard immunisation chart. Standard immunisation are covered on certain Medical Scheme options as part of the health and benefit booster for children younger than 7 years (vaccine only).

 

  • Flu vaccination

 

  • Tetanus vaccine

 

  • HPV vaccine
Irritable bowel syndrome

Irritable bowel syndrome

Also referred to as IBS or spastic colon, is a disorder characterized by abdominal pain; cramping and changes in bowel movements (diarrhea or constipation). These symptoms range from mild to severe.

Calendar month

Calendar month

Means a period extending from the first day to the last day of any one of the twelve (12) months of the year.

Cardiac failure

Cardiac failure

Failure of the heart.

Cardiac or heart failure (also called congestive heart failure) is the inability of the heart to supply sufficient blood flow to meet the needs of the body. This can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography (ECG) and blood tests. Treatment commonly consists of lifestyle measures (such as smoking cessation, light exercise including breathing protocols, decreased salt intake and other dietary changes) and medications, and sometimes devices or even surgery.

Common causes of heart failure include myocardial infarction (heart attack) and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy. The term “heart failure” is sometimes incorrectly used to describe other cardiac-related illnesses, such as myocardial infarction or cardiac arrest.

Cardiomyopathy

Cardiomyopathy

A primary disease of the heart muscle in the absence of a known underlying etiology.

Caries

Caries

The microbial destruction of the tooth material.

Chlamydia

Chlamydia

A specific group of bacteria

Claim

Claim

After you’ve received medical treatment, you or the service provider (the doctor or hospital) submits a claim to your medical scheme to request payment of the bill. Usually you can wait for your scheme to pay out the claim, or you can pay the bill from your own pocket and then claim back the money from your scheme.

Coronary artery disease

Coronary artery disease

Coronary artery disease is caused by atherosclerosis (the development of fatty plaques on the inner walls of arteries) with eventual restriction of blood flow. This may lead to angina pectoris or heart cramp, and lead to myocardial infarction (the death of a segment of the heart muscle caused by an interruption of its blood supply), causing the patient to suffer a “heart attack” (sudden severe chest pain), cardiac arrest, heart arrhythmias, or other complications.

Risk factors include a diet high in cholesterol, saturated fats and refined carbohydrates, hypertension, diabetes mellitus, obesity, lack of exercise, smoking, excessive alcohol intake, and high levels of stress.

Agreed tariff

Agreed tariff

The cost of a service negotiated by a fund with a preferred provider, like doctors and hospitals. These providers are referred to as DSP’s (Designated Service Providers) and, if you are on such a scheme, you can only see those specific providers. http://www.medicalaid.co.za/MedicalAid/Dictionary.aspx

Late Joiner Penalty

Late Joiner Penalty

If you join a medical aid later in life, you have to pay a Late Joiner Penalty. This premium penalty varies between 5% and 75% of the monthly premium and is payable for the duration of membership. All medical aids charge Late Joiner Penalties and they may be carried over from one scheme to another.

Limit

Limit

A limit is the maximum benefit amount which is paid for a specific service, apparatus or appliance, for example in the case of prostheses.

Lingual orthodontics

Lingual orthodontics

A more cosmetic method of orthodontic treatment where the braces are not visible.

Lipectomy

Lipectomy

The surgical removal of fatty tissue.

Cosmetic

Cosmetic

To beautify.

Back treatment programme

Back treatment programme

A non-surgical intervention in lieu of surgery for the management of spinal column disease/conditions/ abnormalities. This new approach to the treatment of back and neck pain is used as an alternative to back surgery, and involves an interdisciplinary team handling the rehabilitation programme, which is individualised for each patient based on the patient’s needs and clinical diagnosis.

Benefit option

Benefit option

A medical plan which offers specific defined benefits in exchange for a monthly subscription fee

Benign prostatic hyperplasia

Benign prostatic hyperplasia

An increase in the size of the prostate, due to hyperplasia (an increase in the number of cells). Nodules form and press on the urethral canal and can obstruct the urethra, making urination difficult and painful.

Designated Service Provider (DSP)

Designated Service Provider (DSP)

A list of doctors and other healthcare practitioners from which you must choose when you need medical care. This reduces the cost, making basic day-to-day medical care available at affordable rates.

Excision of a nail

Excision of a nail

A nail excision is when the nail (toenail) and sometimes the nail bed from which the nail grows is removed surgically or destroyed

Exclusions

Exclusions

Exclusions are medical conditions which a medical aid scheme is legally permitted to exclude from its health insurance offering. Examples are self-inflicted injuries and cosmetic surgery.

Emergency medical condition

Emergency medical condition

An emergency medical condition means any sudden and unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide such treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy. An emergency medical condition must be certified as such by a medical practitioner. Emergencies qualify for PMB and must therefore also be registered for PMB (see also “PMB”).

Composition of subscription

Composition of subscription

This shows how your subscription is calculated.

Mammogram

Mammogram

A diagnostic and screening tool which uses low-dose X-rays to examine breast tissue, in an attempt to detect breast cancer early.

Mammoplasty

Mammoplasty

Surgery to the breasts

Medical scheme plan

Medical scheme plan

A medical scheme makes provision for the obtaining of health services, and grants assistance in defraying the expenses of such health services. Medical schemes offer various plans suited to different income levels and needs.

Medicine

Medicine

A substance or mixture of substances which is accepted as being ethical by medical science and which is registered with the South African Medicines Control Council, to be administered or applied for the prevention, treatment or healing of an illness (see also “chronic medicine” ).

Membership certificate

Membership certificate

Proof that you have been a member of Medical Scheme for a specific period.

Membership enquiries

Membership enquiries

Enquiries about monthly membership fees, debit orders, dependants, suspensions, certificates and benefit option changes.

Menopausal symptoms

Menopausal symptoms

Women may suffer from menopausal symptoms when the ovaries cease to produce an egg cell every four weeks, and menstruation ceases. The menopause can occur at any age, normally between the middle thirties and middle fifties, commonly between 45 and 55. During menopause there are marked changes in the menstrual cycle – menstruation may decrease gradually in successive periods or the intervals between periods may lengthen, or alternatively periods may stop abruptly. There is a change in the sex hormones in the body, which may lead to hot flushes and other symptoms including palpitations or emotional disturbances. Some of these symptoms may be alleviated through hormone replacement therapy (HRT).

MMAP – Maximum Medical Aid Price

MMAP – Maximum Medical Aid Price

The reference price used by Medical Schemes to determine benefits for non-chronic and chronic medicine. The MMAP is the average price of all the available generic equivalents for an ethical patented medicine item.

MSA (Medical Savings Account)

MSA (Medical Savings Account)

The medical savings plan is designed to cover day-to-day expenses. The consumer contributes a fixed monthly amount into a savings account. The total annual amount available in the savings account is available in advance for medical expenses.
In terms of the medical schemes regulations, the amount may not be more than 25% of his premium for the year. Once the benefit has been used up, the consumer is responsible for the day-to-day expenses. Any positive balance in the savings account at the end of the year is carried over to the next year.

Myringotomy

Myringotomy

A surgical procedure in which a tiny incision is made in the eardrum to relieve pressure and aid the draining or fluid or pus from the middle ear. A tympanostomy tube is inserted into the middle ear to prevent the incision from closing and to facilitate drainage of fluid.

Multiple sclerosis

Multiple sclerosis

A common demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord.

National Health Reference Price List (NHRPL)

National Health Reference Price List (NHRPL)

The NHRPL is a guide to the tariffs which healthcare practitioners should charge for various services. It’s compiled by the Council of Medical Schemes, on behalf of the Department of Health.

Network provider

Network provider

Medical Schemes has agreements with designated service providers to deliver healthcare services at competitive rates. Healthcare professionals who are part of a Medical Scheme designated service provider networks, including general practitioners; dentists; optometrists and pharmacies, are known as network providers.

Oestradiol

Oestradiol

The most potent naturally occurring estrogen

 

Optipharm

Optipharm

The preferred provider for the rendering of HIV/Aids-related services and post-exposure prophylaxis in the case of sexual assault.

Orthognatic surgery

Orthognatic surgery

Jaw correction surgery.

Out-of-network provider

Out-of-network provider

A healthcare service provider who is not one of the Medical Schemes designated service providers.

Parkinson’s disease

Parkinson’s disease

A neurological syndrome usually resulting in deficiency in of the neurotransmitter dopamine as the consequence of degenerative, vascular or inflammatory changes in the basal ganglia.

Per year

Per year

Per year means from 1 January to 31 December of a year. Should a member enrol within a financial year, benefit amounts will be prorated according to the remaining number of months of the year. All limits are valid for a year unless otherwise indicated, e.g. for spectacles available per 24-month cycle.

Pneumococcal conjugated

Pneumococcal conjugated

Pneumococcal Conjugate Vaccine is a vaccine used to protect babies and young children against diseases, including pneumonia, caused by the pneumococcus bacterium (Streptococcus pneumonia).

PMB

PMB

Prescribed Minimum Benefits

Polio

Polio

Poliomyelitis is a disease caused by infection with poliovirus. It affects the central nervous system and can lead to full or partial paralysis. Spinal polio is the most common form of the disease; it’s characterised by partial or full paralysis of the legs.

Pooled per family

Pooled per family

Benefits available per beneficiary are combined and the total benefit is then available to any member of the family.

Pre-authorisation

Pre-authorisation

Pre-authorisation means benefits for a service must be authorised before it is rendered.

Pre-registration

Pre-registration

This applies to hospital admissions, and means that hospital admissions must be registered in advance with your Medical Scheme.

Prescribed Minimum Benefits (PMB)

Prescribed Minimum Benefits (PMB)

Prescribed Minimum Benefits (PMB) are paid for 26 chronic illnesses on the Chronic Diseases List (CDL) and 270 medical conditions with their treatments as published in the Regulations of the Medical Schemes Act, 1998 (Act No 131 of 1998). In terms of these Regulations, medical schemes are compelled to grant benefits for the diagnosis, treatment and care costs of any of these conditions as well as emergency medical conditions (that meet the published definition) without imposing any limits. PMB are subject to pre-authorisation, pre-registration, protocols, and the utilisation of designated service providers, where applicable (e.g. the South African Oncology Consortium for cancer treatment).

Preventive Care

Preventive Care

Preventative health care consists of measures – for example screening tests or vaccinations – to prevent illness, disease or injury, to maintain a better standard of general health and therefore quality of life, ultimately minimising the risk of long-term health consequences.

Private nursing

Private nursing

A service rendered to patients at their home instead of in hospital. These services typically exclude day-to-day services such as bathing and general care.

Prolactin

Prolactin

A protein hormone that stimulates milk secretion.

Protocols

Protocols

Clinical guidelines compiled by experts in the field of a specific medical condition for the treatment of that condition based on best practice principles.

Referrals

Referrals

Referrals are required when a general practitioner requires a patient to undergo radiology or pathology tests or to visit a specialist. The general practitioner will then supply you with a referral letter.

Reflux surgery

Reflux surgery

  • Anti-reflux surgery is surgery to correct a problem with the muscles at the bottom of the esophagus (the tube from your mouth to the stomach).
  • Problems with these muscles allow gastroesophageal reflux disease (GERD) to happen.
  • GERD is a condition that causes food or stomach acid to come back up from your stomach into your esophagus.
  • This is called gastroesophageal reflux. It can cause heartburn and other uncomfortable symptoms.
  • Reflux occurs if the muscles where the esophagus meets the stomach do not close tightly enough.
  • The procedure is a Hiatus hernia repair.
Refractive surgery

Refractive surgery

Surgery in which the shape of the cornea is modified.

Relevant PMB code

Relevant PMB code

Your doctor will be able to provide these code(s).

Rumatoïede artritis

Rumatoïede artritis

Rumatoïede artritis is ’n chroniese, sistemiese inflammasiesiekte wat verskeie weefsels en organe kan affekteer, maar wat hoofsaaklik die sinoviale gewrigte aantas, dit wil sê die vrybewegende gewrigte waarvan die punte van die bene met kraakbeen bedek is en verbind word met ’n ligament wat uitgevoer is met ʼn sinoviale membraan wat sinoviale vog afskei.  Die proses veroorsaak ontsteking van die sinovium/slymvlies (sinovitis/gewrigsontsteking) as gevolg van hiperplasie/vermeerdering van sinoviale selle, oortollige sinoviale vloeistof en die ontwikkeling van pannus in die sinovium.  Die patologie van die siekteproses lei dikwels tot die vernietiging van die gewrigskraakbeen en ankilose/verstywing van die gewrigte. Rumatoïede artritis kan ook veroorsaak dat ontsteking versprei na die longe, perikardium/hartsak, pleura/longvlies en sklera.  Dit het ook knopperige letsels tot gevolg, veral in weefsel onder die vel.  Hoewel die oorsaak van rumatoïede artritis onbekend is, speel outo-immuniteit ‘n belangrike rol in beide die chronisiteit/langdurigheid en vordering.  Rumatoïede artritis word beskou as ‘n sistemiese outo-immuun siekte.

Rumatoïede artritis kan op verskeie maniere behandel word.  Niefarmakologiese behandeling sluit in fisioterapie, ortose, arbeidsterapie en voedingsterapie, maar dit kan nie die voortgesette vernietiging van ʼn gewrig stop nie.  Pynstillers en anti-inflammatoriese middels, insluitend kortikosteroïede, word gebruik om die simptome te onderdruk, terwyl antirumatiese middels nodig is om die onderliggende immuunproses te vertraag of te stop en langtermynskade te voorkom.  Meer onlangs het die nuwe groep biologiese middels behandelingsopsies laat toeneem.

Rheumatoid arthritis

Rheumatoid arthritis

A systemic disease that affects connective tissue, and of which arthritis is the dominant clinical manifestation. It involves many joints (particularly hands and feet) accompanied by the thickening of articular soft tissue, with extension of the synovial tissue over articular cartilages, which become eroded.

Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints (a freely movable joint, where the ends of the bone are covered with cartiledge, and linked by a ligament lined with synovial membranes which secrete synovial fluid). The process produces an inflammatory response of the synovium (synovitis) secondary to hyperplasia of synovial cells, excess synovial fluid, and the development of pannus in the synovium. The pathology of the disease process often leads to the destruction of articular cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, pericardium, pleura, and sclera, and also nodular lesions, most common in subcutaneous tissue. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in both its chronicity and progression, and rheumatoid arthritis is considered a systemic autoimmune disease.

 

Various treatments are available. Non-pharmacological treatment includes physical therapy, orthoses, occupational therapy and nutritional therapy but do not stop progression of joint destruction. Analgesia (painkillers) and anti-inflammatory drugs, including corticosteroids, are used to suppress the symptoms, while disease-modifying anti-rheumatic drugs (DMARDs) are required to inhibit or halt the underlying immune process and prevent long-term damage. In recent times, the newer group of biologics has increased treatment options.

Rumatoïede artritis

Rumatoïede artritis

Rumatoïede artritis is ’n chroniese, sistemiese inflammasiesiekte wat verskeie weefsels en organe kan affekteer, maar wat hoofsaaklik die sinoviale gewrigte aantas, dit wil sê die vrybewegende gewrigte waarvan die punte van die bene met kraakbeen bedek is en verbind word met ’n ligament wat uitgevoer is met ʼn sinoviale membraan wat sinoviale vog afskei.  Die proses veroorsaak ontsteking van die sinovium/slymvlies (sinovitis/gewrigsontsteking) as gevolg van hiperplasie/vermeerdering van sinoviale selle, oortollige sinoviale vloeistof en die ontwikkeling van pannus in die sinovium.  Die patologie van die siekteproses lei dikwels tot die vernietiging van die gewrigskraakbeen en ankilose/verstywing van die gewrigte. Rumatoïede artritis kan ook veroorsaak dat ontsteking versprei na die longe, perikardium/hartsak, pleura/longvlies en sklera.  Dit het ook knopperige letsels tot gevolg, veral in weefsel onder die vel.  Hoewel die oorsaak van rumatoïede artritis onbekend is, speel outo-immuniteit ‘n belangrike rol in beide die chronisiteit/langdurigheid en vordering.  Rumatoïede artritis word beskou as ‘n sistemiese outo-immuun siekte.

Rumatoïede artritis kan op verskeie maniere behandel word.  Niefarmakologiese behandeling sluit in fisioterapie, ortose, arbeidsterapie en voedingsterapie, maar dit kan nie die voortgesette vernietiging van ʼn gewrig stop nie.  Pynstillers en anti-inflammatoriese middels, insluitend kortikosteroïede, word gebruik om die simptome te onderdruk, terwyl antirumatiese middels nodig is om die onderliggende immuunproses te vertraag of te stop en langtermynskade te voorkom.  Meer onlangs het die nuwe groep biologiese middels behandelingsopsies laat toeneem.

Rhinoplasty

Rhinoplasty

Surgery to the nose

Rotavirus

Rotavirus

The most common cause of severe gastroenteritis in children worldwide, rotavirus is transmitted via the faecal-oral route. Symptoms include vomiting, diarrhoea and fever. A vaccination for Rotavirus is now available for children.

SAOC

SAOC

The SAOC is the South African Oncology Consortium, the professional affiliation of South African oncologists who determine the guidelines according to which patients receive cancer treatment.

Savings account

Savings account

The savings account contribution is a fixed monthly amount which is included in the member’s monthly contribution, and a credit facility is immediately available at enrolment.

Savings account reconciliation

Savings account reconciliation

A statement indicating funds allocated to your savings account, and claims paid from it.

Scheme tariff

Scheme tariff

Scheme tariff is the tariff as approved by the Board of Trustees.

Schizophrenia

Schizophrenia

A common type of psychosis, characterised by a disorder in perception, content of thought and thought processes (hallucinations and delusions), and extensive withdrawal of one’s interest from other people and the outside world.

Subacute facilities

Subacute facilities

Also known as step-down facilities, these facilities offer a service to patients who are healthy enough to be discharged from hospital, but still need professional care which cannot normally be rendered at home.

Systemic lupus erythematosus

Systemic lupus erythematosus

An inflammatory connective tissue disease with variable features including fever weakness and fatigability, joint pains or arthritis resembling rheumatoid arthritis, diffuse erythematous skin lesions on the face, neck or upper extremities, lymphadenopathy, pleurisy or pericarditis, glomerular lesions, anaemia hyperglobulinaemia and a positive LE cell test.

Subscription statements

Subscription statements

A statement showing the amount of your subscriptions and any arrears due for a particular month.

Tax certificate

Tax certificate

These certificates display the amount deductible from your income tax.

Tetanus

Tetanus

Tetanus is caused by the Clostridium tetani bactium, which gains entry to the body through open wounds. It causes spasms in the body and jaw, eventually leading to lockjaw (the jaw locks). Death can result from breathing difficulties.  A vaccination for tetanus is available.

Tonsillectomy

Tonsillectomy

Surgical removal of the palatine tonsils, at the back of the throat. Tonsils play a role in protecting the body against foreign pathogens.

Trauma care

Trauma care

Trauma care includes benefits for trauma in the case of motor vehicle accidents, stab and gunshot wounds that require hospitalisation, as well as prophylaxis in the event of sexual assault, and benefits for head trauma, burns and near drowning.

To-take-out medicine (TTO)

To-take-out medicine (TTO)

Means medicine to take out at the time of discharge from a hospital or day clinic, which medicine directly pertains to the reason for the admission to the hospital or day clinic and which is dispensed and charged by the hospital or day clinic on prescription of the attending physician.

 

Ulcerative colitis

Ulcerative colitis

A chronic disease of unknown cause characterised by the ulceration of the colon and rectum.

Underwriting

Underwriting

An undertaking to finance or otherwise support (or guarantee) something

Depending on your previous medical scheme history, your new medical scheme can apply underwriting on your new membership. This means that, according to regulation, they are allowed to impose a three-month general waiting period and/or a twelve-month waiting period on an existing illness condition. A Late Joiner Penalty can also be placed.  http://www.medicalaid.co.za/MedicalAid/Dictionary.aspx

Update my contact details

Update my contact details

An easy way of changing your contact and other details.

Uvulopalatopharyngioplasty

Uvulopalatopharyngioplasty

Surgery to the uvula or the roof of the mouth

Vascular/cardiac prostheses

Vascular/cardiac prostheses

Vascular/cardiac prostheses include artificial aortic valves, pacemakers and related or connected functional appliances.

VDRL

VDRL

A flocculation test for syphilis.

Registreer / Register

Maak toe / Close