Terms Used By Medical Aid Schemes

There are certain terms that are used by medical aid schemes, and if you do not know these terms you will be unable to figure out what it means. Knowing these terms is helpful because then you are not left wondering what a certain term means, and that will help you to understand your medical scheme better.

Here are some terms that are used by medical aid schemes:

Acute Medicine

This is medicine used for disease conditions that are progressively getting worse, and you are showing major symptoms of that particular disease.

Agreed Tariff

An agreed tariff is a tariff that doctors and hospitals has agreed too. Tariffs are a fee or price that has to be paid.

Beneficiary dependants

This is a member who receives benefits. This is usually for family or step-family or a pre-agreed upon person.

Chronic Diseases

Chronic diseases are diseases that are ongoing diseases. This means that the disease will last 3 months or more, depending on the disease. Anything with the word chronic ahead of it means that it will last for a long period of time.

Chronic Medicine

This is a medicine type that is prescribed to a patient for a period of 3 months or more. People who are on chronic medicine will typically be dealing with a chronic disease, and so they are need of chronic medicine in order to stay healthy.


Consultation is a fancy word for visiting your doctor or specialist. A consultation is usually made in order to help treat a certain disease. Consultations are useful in the sense that they can help you to be diagnosed.


A co-payment means that this will be the portion of the bill that the member of the medical aid scheme will be responsible for. Very rarely do medical aid companies pay for the full medical bill, and the portion that they do not pay for will be what the member pays for.

Late Joiner

This is a person who is 35 or older than 35. A late joiner is someone who has not been a member of a medical aid scheme for the past 2 years. Because the person has not been a member for more than 2 years they may be charged a late joiner penalty.


This is an individual who gives specialised medical treatment that a general health physician cannot provide.

For example, this will include:

  • Gynaecologist
  • Cardiologist
  • Proctologist
  • Urologist

Waiting Period

A waiting period is a period of time where an individual has no benefits that are paid. This may take up to 12 months. Sometimes a waiting period may cover certain things, so knowing what it will cover is important.


This is someone who is 21 years or older than 21 in a medical scheme.

Adult Dependant

This is an adult who is dependant on the main member of the medical aid scheme. Oftentimes, this will be adult children who are still living at home.


This is sometimes mentioned, and all that it means is aids or HIV.

Ambulance Services

This when the ambulance has to go and pick someone up.

If you understand these medical terms, then you will better be able to comprehend your medical aid scheme. That is the advantage of knowing these terms that are used by medical aid schemes.