Skip links

Medical Insurance Glossary

What is an emergency?

An event or unexpected health condition, which if not treated immediately, would result in death or serious bodily impairment. E.g. Heart attack or stroke.

 

What is an accident?

An accident means bodily injury caused by violent accidental and external physical means. E.g. Motor vehicle accident, burns, injuries from a crime, snake bite, or injuries from a fall.

 

What does ‘Principal Insured Person’ mean?

  • The person who has completed the application form and who has been accepted by the Underwriting Manager on behalf of the Company as eligible for participation in the insurance provided by this policy; or
  • The eldest person who has not attained the age of twenty-one (21) for who an application form has been completed and who has been accepted by the Underwriting Manager on behalf of the Company as eligible for participation in the insurance provided by this policy.

 

What is meant by ‘Adult Dependent’?

  • The spouse of the Principal Insured Person who is not already insured under this policy or any other policy issued by the Company providing similar cover and where the spouse shall include a party to any union recognised by South African Law; or
  • A child who has attained the age of twenty-one (21) and who is the natural/biological child, or stepchild, or legally adopted child placed under the foster care of the Principal Insured Person, who is not already insured under this policy or any other insurance issued by the Company providing similar cover, and who is financially dependent on the Principal Insured Person.

 

What does ‘Eligible Child’ mean?

  • A child who has not attained the age of twenty-one (21) and who is the natural/biological child, or stepchild, or legally adopted child placed under the foster care of the Principal Insured Person, who is not already insured under this policy or any other insurance issued by the Company providing similar cover; or
  • A child who has not attained the age of twenty-one (21) and who has at least one parent in common with the Principal Insured Person as defined above and who is not already insured under this policy or any other insurance issued by the Company providing similar cover.
  • There will be no age restriction for children who are either mentally or physically incapacitated, always provided that the children are wholly dependent on the Principal Insured Person for support and maintenance.

 

What is a “Senior Extender”?

The senior premiums are specifically designed for our clients over 56. This policy is subject to open enrolment, community rating and cross-subsidisation. These additional premiums may be waived if the applicant can demonstrate healthcare insurance coverage for 15 or more years since the age of 35.

 

What does ‘Insured Person’ mean?

  • A Principal Insured Person, an Adult Dependent or an Eligible Child of a Principal Insured Person.
  • Such other person as the Company may from time to time deem eligible.

 

What does “Network” mean?

A selected group of service providers with which the Underwriting Manager has a contract.

 

What does “Medical Treatment” mean?

Any form of investigation or examination by or consultation with or a surgical procedure performed by a Medical Practitioner for the purpose of treating or monitoring an Insured Person’s medical condition.

 

What is an acute condition?

A short-term condition or illness like a chest infection, sinusitis or the flu. Your GP can give you acute medication to treat your condition/illness, or write a script for you to get the medication at a pharmacy.

 

What is a formulary?

A medicine formulary is a list of approved medicines. Only medications that are on this list will be covered. This ensures that premiums stay affordable.

 

What is a chronic condition?

A condition or disease that lasts for an extended period of time.

 

What does “Waiting Period” mean?

The period from the policy commencement date or the date an Insured Person is added to this policy until benefits become payable under this policy.