General Knowledge

An application is received for Gerald (age 10) to visit a neuro surgeon for a rare neural condition which the GP cannot manage. Elsa (mom) calls in to follow up if the application has been referred yet.

Which panel was the process referred to?

• Clinical

• Physician

• Neuro

• Paed

When members change to a variable debit order date from the 1st of the month, the following will happen:

Select the incorrect option:

• They will be debited twice in the month of the change

• Their billing will automatically change to advance

• They can skip the first debit order and pay double on the variable date without being suspended

• They can only change the debit order date once per month

For KIV which of the below options is considered as income?

Select the correct option:

• Income from leasing of assets or property

• Distributions received from a trust, pension and/or provident fund

• Receipt of any financial assistance in terms of any statutory social assistance programme

• Interest from investments

• All of the above

Which members do not need to provide proof of income as part of the KIV process?

Select the correct options:

• Members 60 years and older

• Members younger than 25

• Employees of large employer group

• Members already on the lowest income band

• Members already on the highest income band

The lowest income band code is?

Select the correct option:

• AC1

• ACB

• AC2

• ACA

The Risk management tool DHMS uses is called ___________?

The name of the system you can view approvals for out-of-hospital benefits is called what?

A member wants to go to a specialist and they have an approved authorisation. What else do they need to check?

Select the correct options:

• Whether they have available funds in the benefit limit

• That the date of the consultation is within the approval period

• The gender of the specialist

• That they do not have COVID

What is the difference between a CTH and a claim statement?

Select the correct option:

• They are the same

• The claim statement is a set monthly statement whereas the CTH can be customised according to the requestor's instructions

• One can be downloaded digitally while the other one cannot

• The CTH includes much more detail than the claim statement

When may you add a dependant to a membership?

• It's a newborn baby and the baby needs urgent medical attention

• The member just got married

• It's your friend

• If you want to override any waiting periods for the member