Administrator: The individual appointed by American Medical Center, P.L.C. to supervise the administration of services covered by WASTINA.
Beneficiary: individual for whom the plan has been purchased for, registered on the second page of the sign up process. “Enrollee”, “Recipient” or “Member” is the synonym that may be alternatively used in any of the WASTINA documents.
Birr: Ethiopian currency.
Brand Name: A prescription drug with a proprietary name assigned to it by the manufacturer or distributor.
Co-payment: A portion of payment made by the member for certain services and treatments as stated in the membership coverage.
Doctor: An individual holding a degree of Doctor of Medicine (MD), Doctor of Dental surgery (DDS), Doctor of Dental Medicine (DDM), or other approved medical license or degree, which allows him/her to provide health services within the scope of his or her license under the laws in Ethiopia.
Generic Drug: A prescription drug, whether identified by its chemical proprietary or nonproprietary name that is accepted by the medical community in Ethiopia as therapeutically equivalent to a brand name drug.
Healthcare Provider: A doctor, nurse, nurse practitioner, health officer, psychologist, social worker, counselor, physical therapist or other professionals to whom the Ethiopian Ministry of Health has granted a license or recognition of expertise/skills.
In-Network Provider: A healthcare provider who participates in the network arrangement made by the Wastina.
Nurse: A person with a nursing degree or diploma from a program recognized by the Ethiopian Ministry of Health.
Medical Emergency: A sudden or unexpected and serious illness or injury necessitating urgent medical services at the nearest healthcare facility. Examples of a medical emergency include convulsions, poisoning, appendicitis, heart attack, loss of consciousness, or life-threatening injuries.
Medically Necessary: Any generally accepted medical service or supply that is:
- Appropriate and necessary for the treatment and diagnosis of a medical condition.
- Not primarily for the convenience or cosmetics of the patient or his/her healthcare provider.
- Within medical standards of medical practice in the community where services are performed.
Preventive Care: Services and supplies provided primarily to maintain a basic level of physical or mental function.
Out-of-Network Provider: A healthcare provider who is not a participant in our providers’ network.
Participating Pharmacy: A pharmacy granted the privilege to participate in the arrangements made by the American Medical Center for Wastina members.
Sponsor: An individual or organization purchasing a WASTINA membership plan for an individual(s) residing in Ethiopia to receive healthcare services through our providers’ network.