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Medical aid glossary

Generic substitution

Dispensing a generic equivalent in place of the originator medicine. Schemes commonly fund only the generic price, leaving the member to pay the difference if they insist on the branded product without a clinical motivation.

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 actBeneficiaryBenefit yearCase managerChronic Disease List (CDL)Chronic medication list (formulary)Chronic registrationClaims shortfallClaims statementClinical motivation

Claim review

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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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