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SA's No 1 Insurance Blog

Are you aware that a South African medical scheme can’t refuse you cover? If you apply to become a member the scheme has to take you on regardless of your age or health status. So if they are obliged to take you on, the assumption is that they can’t kick you off?

That’s correct. Once a member your medical scheme can’t simply ask you to leave. Well, unless they have justification!
What type of reasons could lead to your membership being terminated?
1. Failure To Pay Your Contributions On Time.
That’s a pretty obvious reason. You’ve committed to paying the premiums, the scheme has committed to providing you with healthcare benefits on receipt of those premiums. If you don’t hold up your end of the bargain all bets are off.
2. Failure To Repay Any Debt?
There might be a situation where as a scheme member you end up owing the scheme some money. Failure to re-pay the debt means your membership is terminated.
3. Submission Of Fraudulent Claims & Committing A Fraudulent Act.
Self explanatory. Try and rip the medical scheme off and your out!
4. Non Disclosure Of Material Information.
Be truthful! Any insurance contract is based on good faith. If you hide information or fail to disclose all the relevant facts not only is your claim going to be repudiated but your membership is going to be canned.
But that’s it. So pay your premiums on time, disclose everything at application stage, don’t try and rip the medical scheme off, and you can rest easy knowing that your scheme can’t ever give you the boot (no matter how heavily you claim)

Are you interested in joining a medical aid scheme?

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Until next time.

The InsuranceFundi Team

 

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