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Medical aid glossary

Benefit year

The twelve-month cycle over which your annual limits, thresholds and savings are calculated — for most South African schemes this runs from January to December. Limits reset at the start of each benefit year, and chronic registrations often need to be reconfirmed.

Where you will see this term

Terms like this appear on claims statements, remittance advices, authorisation letters and scheme rules. Understanding the exact wording your scheme used is usually the first step in working out whether a rejected or short-paid claim can be disputed.

Browse the full glossary.

Related terms

Above Threshold Benefit (ATB)Annual limitAuthority to actBeneficiaryCase managerChronic Disease List (CDL)Chronic medication list (formulary)Chronic registrationClaims shortfallClaims statementClinical motivationCo-payment

Claim review

Not sure what your scheme's wording means for your claim?

Send us the rejection letter, the itemised account and the clinical notes. We translate the scheme's reasoning into plain English and tell you whether the decision stands up against its own rules and the Prescribed Minimum Benefit regulations.

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This page is provided for general information and does not constitute legal or medical advice. Medical scheme rules, benefit structures and regulations change over time — always confirm the position with your scheme’s current member material, your treating practitioner, or an attorney admitted in South Africa.

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ClaimIQ is a product of Landlodz (Pty) Ltd (Reg. No. 2024/615543/07).
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ClaimIQ SA is an independent medical aid claim review and dispute service. We are not a medical scheme, a broker or a financial services provider.