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FREQUENTLY ASKED QUESTIONS
GLOSSARY OF TERMS
National Health Reference Price List (NHRPL)
The NHRPL is an independent guideline of fees for medical services compiled by the Council for Medical Schemes. Medical Schemes may elect to reference their benefit reimbursements in relation to this List.
Prescribed Minimum Benefits (PMBs)
The PMBs are the minimum level of benefits that any scheme may provide in terms of the Medical Schemes Act. The conditions are listed in the Act and covers mostly hospital based treatment and treatment for a list of chronic conditions referred to as the Chronic Disease List (CDL).
These benefits are subject to a number of management tools such as making use of a Designated Service Provider (DSP) to provide diagnosis, pre-authorisation and treatment in terms of clinical protocols and criteria. Medicines for CDL conditions are further subject to medicine formularies. If members comply with these rules PMBs are covered at cost with no co-payment.
Designated Service Provider (DSP)
A healthcare provider or group of providers selected by the scheme to provide a diagnosis, treatment and care in respect of one or more prescribed minimum benefit conditions.
Ex-Gratia
Members may apply for ex-gratia payments in respect of the cost of medical treatment not covered in terms of the Rules of the Scheme, for example when benefit limitations have been reached.
Ex-gratia payments are granted by a sub-committee of the Board of Trustees, at their sole discretion and are usually only granted in exceptional circumstances.
ChroniLine
ChroniLine is a paperless system for the authorisation of chronic medication provided by Mediscor.
Chronic Medication
On-going, prescribed medication obtained monthly for the treatment of chronic conditions
Acute Medication
Short term prescribed medication taken for a temporary illness or conditions such as infections, relieving of symptoms etc.
Pharmacy Assisted Therapy (P.A.T)
Medication purchased at a pharmacy for minor illness on the advice of a pharmacist
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