Medical coverage – a pesky 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 short comparison of tariffs
- additional products to fill shortcomings in your medical product; and
- access to free advice for Solidarity World visitors by an accredited advisor.
Gapingsdekking Advies
’n Noodsaaklike aanvullende produk – gapingsdekking
Alhoewel mediese skemas die gemoedsrus bied dat jy toegang tot mediese dienste het, word nie alle mediese dienste noodwendig ten volle deur mediese skemas betaal nie. Sekere spesialiste hef ook aansienlik meer vir prosedures as dit wat die mediese skema betaal. Mediese skemas vereis boonop bybetalings op sekere prosedures in die hospitaal. Jy sal vir hierdie verskille moet opdok as jy nie ’n gapingsdekkingproduk (link na leidraadvorm oor gapingsdekking) het nie en dit kan etlike duisende rand beloop.
Wat is gapingsdekking?
- Jy moet ’n lid van ’n geregistreerde mediese skema wees om gapingsdekking te kan uitneem.
- Dit kan so min as R196 per maand kos, afhangend van jou profiel en die opsie wat jy kies. Indien jou werkgewer instem dat gapingsdekking vir die groep bekom word, kan dit selfs minder kos.
- Dit dek hoofsaaklik kortbetalings en bybetalings op prosedures wat binne die hospitaal uitgevoer word.
- Sekere tipes gapingsdekking bied ook addisionele dekking vir lewensbedreigende siektes soos kanker.
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Kry betroubare advies
Om ̓n mediese fonds of ̓n gapingsdekkingsproduk te kies, of om van versekeraar of skema te verwissel, is ’n moeisame en komplekse proses met verskeie reëls en voorwaardes wat geld. ̓n Geakkrediteerde adviseur kan jou help om die proses pynloos te maak, teen geen addisionele koste nie.
Geakkrediteerde adviesAdviseurs moet aan verskeie wetlike vereistes voldoen alvorens hulle advies kan lewer. Dit sluit in formele eksamens in versekeringswette wat hulle moet slaag en verdere opleiding in finansiële dienste wat hulle moet deurloop. Ten einde ̓n mediese skema se produkte te kan aanbied, moet ̓n adviseur ook ̓n formele ooreenkoms met die skema in plek hê en ook produkopleiding ondergaan. Adviseurs is voorts verplig om alle beskikbare opsies aan kliënte te bied en op voorwaardes en bepalings te wys, wat kliënte in staat sal stel om ingeligte besluite te neem. Kliënte betaal nie vir hierdie dienste nie. Die mediese skema betaal wel kommissie aan die adviseur vir nuwe besigheid. Dié kommissie word dan ook gereguleer.
Solidariteit het Tendahealth aangestel om mediese en verwante dienste aan lede van die Solidariteit Beweging te lewer. Deur Tendahealth as jou adviseur aan te stel, kry jy dus gratis toegang tot hierdie dienste. Tendahealth het ̓n ooreenkoms met Solidariteit gesluit waarvolgens ̓n gedeelte van die gereguleerde kommissie wat aan Tendahealth betaal word, deur mediese skemas teruggeploeg word in die Beweging. Klik hier om die dienste te bekom en ̓n adviseur sal jou terugskakel.
VerklaringTendahealth (Edms.) Bpk., Reg. No. 2012/105834/07
Tendahealth is ̓n gemagtigde verskaffer van finansiële dienste (FSP No. 44680)
RMS-akkreditasie: ORG.4268
Vergoeding: Tendahealth verdien kommissie onderhewig aan die bepalings van die Wet op Mediese Skemas, No. 131 van 1998, en die Wet op Korttermynversekering, No. 53 van 1998.
Klagte: Tendahealth het ̓n klaghanteringsproses wat op ons webblad of via enquiries@tendaonline.co.za beskikbaar is. Moenie huiwer om ons te kontak indien jy enige vrae het nie.
Tendahealth se nakomingsbeampte is Masemola Mosefe en kan gekontak word by:
082 509 1115
mmaselola@mosefe.co.za
Indien ons nie in staat is om die klag op te los nie, kan dit na die FAIS-korttermynversekeringsombudsman verwys word.
Tik addiction
Support groups_ Tik addiction Support groups are places where people can meet in a safe environment to express their feelings and fears, and get support, advice and guidance from others who know what it feels like to be addicted to drugs, or care about someone who is. Having any illness can be very isolating … Read more
Dementia
Support groups: Dementia Support groups are places where people can meet in a safe environment to express their feelings and fears, and can get support, advice and guidance from others who know what it feels like to care for someone with dementia. Having any illness can be very isolating and you may feel very … Read more
Bipolar Disorder
Support groups for Bipolar Disorder Living and dealing with bipolar disorder is not easy for the person living with it or their loved ones. Knowledge and recognition of the illness by all concerned can prevent a lot of unnecessary pain and suffering, and this is where support groups play a vital role. Shared experiences of … Read more
Attention deficit hyperactivity disorder (ADHD)
Support groups: Attention deficit hyperactivity disorder (ADHD) One of the most important support groups is the Attention Deficit & Hyperactivity Support Group of Southern Africa (ADHASA). They can be contacted – on the website at http://www.adhasa.co.za, by e-mail to adhasa@telkomsa.net, at ADHASA National Office, Delta Park School, Standard Drive, Blairgowrie, Randburg, during weekdays … Read more
Social anxiety disorder
Support groups_ Social anxiety disorder Support groups offer a place where people can meet in a safe environment to express their feelings and fears, and get support, advice and guidance from others who know what it feels like living with social anxiety disorder or who love someone who does. Having any illness or disorder … Read more
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.
ABCDEFGHILMNOPRSTUVAcute 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.
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.
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.
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.
The surgical removal of a dental root apex.
The actual date on which the scheme receives an application for membership or registration of a dependant.
Ability to acquire a skill
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
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.
A vaccine against tuberculosis (TB) prepared from a stain of weakened live bovine (cow) tuberculosis bacillus.
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 enlargement
Breast enlargement.
The chronic dilation of the bronchi or bronchioles as a sequel of inflammatory disease or obstruction.
Tooth grinding.
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.
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 disease of the kidneys.
Regional enteritis; a chronic enteritis of unknown cause, involving the terminal ileum and less frequently other parts of the gastrointestinal tract
Benefits covering the everyday services offered by your general practitioner
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.
A one-off debit order request to spare you the trouble of making online payment or visiting your bank.
South Africa’s leading dental benefit management company.
The surgical removal of all remaining teeth.
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.
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.
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.
Defective rhythm.
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.
(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.
An advanced diagnostic tool.
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.
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.
The removal of hair.
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 shall only be considered where the patient suffers from an abdominal aortic aneurysm with an accompanying high risk for anaesthesia.
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
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.
A condition due to the excessive intake of fluoride.
The surgical removal of a frenum or fold.
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.
The surgical treatment of a defect to the stomach or lower oesophagus by using the stomach wall for reconstruction.
The surgical removal of unsupported gum tissue.
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 is the tariff as approved by the Board of Trustees and contractually agreed with service providers, which includes per diem, fixed and global fees.
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 influenzae type b (or Hib), is a bacterium which causes meningitis and pneumonia. Unlike the name suggests, it does not cause influenza.
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 necessarily replace a part of the body or a component thereof, or perform an essential function of the body.
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 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 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.
A service rendered to patients who are terminally ill to make their last days as comfortable as possible – especially cancer patients.
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”).
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 (hymenotomy) is a minor medical procedure involving the surgical removal or opening of the hymen (the layer over the vagina).
The presence of abnormally high concentrations of lipids in the circulating blood.
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 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 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.
Diminished production of the thyroid hormone.
Radiography of the uterus and uterine tubes after an opaque fluid has been injected.
The attending doctor will be able to provide you with these codes.
ICON -add
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
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.
Means a period extending from the first day to the last day of any one of the twelve (12) months of the year.
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.
A primary disease of the heart muscle in the absence of a known underlying etiology.
The microbial destruction of the tooth material.
A specific group of bacteria
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 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.
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
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.
A limit is the maximum benefit amount which is paid for a specific service, apparatus or appliance, for example in the case of prostheses.
A more cosmetic method of orthodontic treatment where the braces are not visible.
The surgical removal of fatty tissue.
To beautify.
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.
A medical plan which offers specific defined benefits in exchange for a monthly subscription fee
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.
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.
A nail excision is when the nail (toenail) and sometimes the nail bed from which the nail grows is removed surgically or destroyed
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.
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”).
This shows how your subscription is calculated.
A diagnostic and screening tool which uses low-dose X-rays to examine breast tissue, in an attempt to detect breast cancer early.
Surgery to the breasts
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.
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” ).
Proof that you have been a member of Medical Scheme for a specific period.
Enquiries about monthly membership fees, debit orders, dependants, suspensions, certificates and benefit option changes.
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).
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.
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.
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.
A common demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord.
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.
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.
The most potent naturally occurring estrogen
The preferred provider for the rendering of HIV/Aids-related services and post-exposure prophylaxis in the case of sexual assault.
Jaw correction surgery.
A healthcare service provider who is not one of the Medical Schemes designated service providers.
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 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 Conjugate Vaccine is a vaccine used to protect babies and young children against diseases, including pneumonia, caused by the pneumococcus bacterium (Streptococcus pneumonia).
Prescribed Minimum Benefits
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.
Benefits available per beneficiary are combined and the total benefit is then available to any member of the family.
Pre-authorisation means benefits for a service must be authorised before it is rendered.
This applies to hospital admissions, and means that hospital admissions must be registered in advance with your Medical Scheme.
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).
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.
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.
A protein hormone that stimulates milk secretion.
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 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.
- 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.
Surgery in which the shape of the cornea is modified.
Your doctor will be able to provide these code(s).
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.
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 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.
Surgery to the nose
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.
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.
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.
A statement indicating funds allocated to your savings account, and claims paid from it.
Scheme tariff is the tariff as approved by the Board of Trustees.
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.
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.
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.
A statement showing the amount of your subscriptions and any arrears due for a particular month.
These certificates display the amount deductible from your income tax.
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.
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 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.
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.
A chronic disease of unknown cause characterised by the ulceration of the colon and rectum.
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
An easy way of changing your contact and other details.
Surgery to the uvula or the roof of the mouth
Vascular/cardiac prostheses include artificial aortic valves, pacemakers and related or connected functional appliances.
A flocculation test for syphilis.