Your medical cover—start to finish!

As a young professional, you are just starting out in the job market. However, you still need a medical aid. So, you start looking and it is all so confusing! We are here to show you that cover can be simple as well as affordable with the Oxygen Hospital Plan, so we’ll look at some key terms.

Alternative services – Additional healthcare professionals such as dieticians, hypnotherapists, acupuncturists and nutritionists.

Beneficiaries – Those individuals you nominate to also be covered by your policy.

Benefits – Healthcare services, procedures and medicines covered by your monthly contribution. The benefits you’ll receive depend on the type of medical aid plan, or option, you choose.

Branded medication – Patent-protected medicines with registered trade names.

Chronic condition – A long-lasting illness or disease that typically requires on-going treatment and care. Often a condition is called chronic if it lasts for more than three months.

Comprehensive cover – A medical aid option that offers both in-hospital and day-to-day benefits.

Consultation – A meeting with an expert, such as a medical doctor, in order to seek advice.

Co-payment – A portion or percentage of healthcare costs not covered by a medical scheme and for which the member is personally liable.

Day-to-day benefits – Cover provided by a scheme for day-to-day expenses such as GP and specialist consultations, prescribed medication and procedures, pathology and radiology conducted out of hospital.

Emergency – An emergency medical condition, also referred to as an emergency, is the sudden and, unexpected onset of a health condition that requires immediate medical and surgical treatment, where failure to provide medical or surgical 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 does not necessarily require a hospital admission.

Excess – After you have laid a claim there may still be an amount outstanding. This is the excess and you are liable for it.

Exclusions – Medical procedures or conditions not covered by a particular medical aid scheme. Common examples of exclusions are cosmetic surgery and self-inflicted injuries.

Generic medication – Non-branded medicine that has the same active ingredient and is similar in strength and performance to branded medication but that’s available at a substantially lower cost.

Healthcare professional – Healthcare professionals are individuals who provide preventive, curative, promotional or rehabilitative healthcare services to people, families or communities. These include general practitioners (GPs), specialists, nurses, physiotherapists, psychologists, dentists, pathologists and radiologists.

In-hospital – This means any time you spend in hospital even if it is only a few hours. You will be formally ‘admitted’ to the hospital and will thereafter receive care.

Insured value – The maximum value to which a condition/hospitalisation/service will be paid. For example, if you have N$500 000 hospital cover, expenses will be covered up to that amount. After that you are liable.

MEDBUX – Includes out-of-hospital medical services such as doctors’ visits and medication, as well as other auxiliary services.

You will not lose any of your MEDBUX balance at the end of the benefit year.

No claim reward programme – A programme that will pay back 20% of your annual premium in cash should you, the policyholder, or your insured beneficiaries not incur any claims against your overall sum insured. This excludes claims to your MEDBUX balance.

Policyholder – Often known as the “main member” this is the person who has registered for the scheme and pays the premium.

Premium – The ‘premium’ is the monthly amount you pay for your cover for medical costs.

The Oxygen Hospital Plan is only one way you can get cover. Need help finding a plan? Talk to us

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