| Acute medication |
| This is all medicine prescribed by a doctor or specialist that is used only for short periods at a time, which does not require preauthorisation,
is not chronic and is not excluded by Pathfinder (which forms part of the medicine formulary applied by Pathfinder).
Medicine can be obtained from any pharmacy of the member’s choice. |
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| Antiretroviral drugs |
| Drugs used in the treatment of viral infections. |
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| Authorisation number |
| This number is given to a member who is requesting pre-authorisation for medical interventions. |
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| Chronic Disease List (CDL) |
| List of chronic conditions identified and legislated, to be treated as part of PMB (Prescribed minimum benefits) using the published list of
approved medications (formulary). |
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| Chronic Medication |
| Prescribed medication approved by the Scheme and paid from the chronic benefit. This medication is used by the patient over an extended
period of time. |
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| Contribution |
| The amount the principal member has to pay monthly to secure membership at Pathfinder. |
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| ICD10 codes |
| Codes that describe the diagnosis (ICD 10) and procedures (CPT) based on the method of classification. |
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| Dependant |
| A dependant is a person who becomes a beneficiary of Pathfinder as part of the principal member’s membership. |
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| Dependant code |
| A unique code allocated to each beneficiary as indicated on the membership card. |
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| Designated Service Provider (DSP) |
| A healthcare provider or group of providers selected by Pathfinder as the preferred provider to provide it’s members with diagnosis,
treatment and care in respect of one or more conditions. |
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| Exclusion |
| An exclusion refers to a service, procedure, treatment or medication which is not covered by the Scheme. |
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| Formulary |
| A list of medicines which will be covered by Pathfinder. Consists of acute and chronic medicines. |
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| National Health Reference Price List (NHRPL) |
| The recommended reference price list or pricing tariffs published by the Council for Medical Schemes, which Pathfinder refers to when
reimbursing service providers. Also known as NHRPL. |
|
| Overall Annual Limit |
| The total benefit limit per family per year. |
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| Pharmacy Advised Therapy (PAT) |
| Medicine dispensed over the counter at a registered pharmacy that does not require a doctor’s prescription and is in line with the Pathfinder
list of approved drugs. |
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| Pathfinder Negotiated Tariff (PNT) |
| A rate negotiated by Pathfinder for the reimbursement of healthcare services. |
|
| Practice number |
| A number issued by the official registering body (Board of Healthcare Funders) to all practices. |
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| Pre-authorisation |
| Permission that must be obtained from Pathfinder for admission to a hospital, treatment in a day clinic, procedures in a surgery and chronic
medication. The scheme will not pay for such services if pre-authorisation was not obtained. |
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| Prescribed Minimum Benefits (PMB) |
| Prescribed Minimum Benefits are the benefits in respect of relevant health services prescribed by the regulations under the Medical Schemes
Act. |
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| Protocol |
| A set of guidelines in relation to the optimal sequence of diagnostic testing and treatment of specific conditions. |
|
| Rules of the Scheme |
| The Rules are a set of laws and benefits approved by the Board of Trustees and the Council for Medical Schemes, which governs the
management of Pathfinder and is binding on Pathfinder, its members, officers and any person who claims any benefits under these Rules. |
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| Tariff code |
| A unique code used for pricing specific medical procedures or services that are used by Healthcare providers. |
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| Waiting period |
| This is a limited period during which a member is excluded from certain services / benefits upon joining Pathfinder. |
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