Understanding how medical aids work will help you chose the right medical aid when you decide to go for one. Certain words that are used in the medical aid industry need to be understood. This enables members to make right decisions about anything related to their chosen schemes.
The average person needs to understand the terms that are used in the industry so that the product can be accessible to them. This is important because there will come a time that a member will need to make a claim. When this happens they must be able to read and understand the documentation.
The Definition Of A Dependent
A dependent is someone who is on the health insurance of the principal member. However they do not make any contributions because they are covered by those that are made by the member already. They are entitled to medical services that they need at any recognized medical facility.
Children of the member under the age of 21 are referred to as child dependents. They are covered for any medical emergency that they could suffer from. Medical aids have different rules relating to how many child dependents a member can have before they start paying extra.
When joining a medical aid you will usually be subjected to what is called a waiting period. This period has to go by before you can start enjoying the benefits of the medical aid. Medical aids do this to guard themselves against any risk that might be presented by a new member.
Once this waiting period has been served things move into a stage which is referred to as creditable coverage. The member and their dependents can now enjoy the benefits of the medical aid. The health insurance will pay for their medical fees whenever they receive medical care at a recognized facility.
Pre Existing Conditions
Pre existing conditions are those sicknesses that a joining member already suffers from. The law requires that the conditions be divulged when a new member comes on board. The health insurers must have made aware of all the pre existing conditions that the member and their dependents have.
A person who becomes a member of a health insurance after they have reached the age of 35 is referred to as late joiner. They also should not have been a member of a medical aid for the preceding two years. Certain penalies can be imposed on them such as an increase in their overall promotions.
An overnight stay at a health facility is referred to as hospital treatment. This category also referrers to situations where a patient is treated with any healthcare machinery. Any major operations will also fall into this category whether done at a clinic or hospital.
Understanding these terms will empower the member and their dependents so that they can know which conditions are covered by the scheme. They will also get to know those conditions that are not covered so that they can make alternative means of getting treatment.