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A life insurer might decline your application outright. Actually, a short term insurer can also decide not to take on your particular risk.  Is it then not possibly for a medical scheme in South Africa to decline your application to join?

Short answer..  They can’t decline you! They can impose terms on your cover (like waiting periods and exclusions on pre-existing conditions) but they can’t give you the “naagh we aren’t interested in your risk bit”

And below is an extract from the particular legislation that makes it very clear that a medical scheme cannot exclude your application to join. It’s from the Medical Schemes Act of 1998 which governs how registered medical schemes in this country operate.

A medical scheme shall not provide in its rules—

(a) for the exclusion of any applicant or a dependant of an applicant, subject

to the conditions as may be prescribed, from membership except for a

restricted membership scheme as provided for in this Act;

 Now let me guess, here is your next question. What is a restricted medical scheme?

Two types of medical schemes exist in South Africa:

1. Open medical schemes

2.  Restricted medical schemes

An open medical scheme (as the name suggests) is open for anyone to join. A restricted medical scheme is restricted to certain applicants.

Should I give you an example of restricted medical scheme? Perhaps it will make it clearer.

Bankmed is a “closed medical scheme”. It was established in 1914 by bankers for bankers (that’s how their website puts it). The scheme covers approximately 100 000 principle members in South Africa’s financial institutions.

It’s the “financial institutions” bit I need to highlight. The scheme isn’t open to the general public only employees of certain financial institutions (and that’s what makes it a closed or restricted scheme)

The bottom line is this. Apply to join an open medical scheme in South Africa and know for a fact that they are obliged to take you on cover.

Are you interested in joining a medical aid scheme?

InsuranceFundi has partnered with some of SA’s most reputable insurance and investment companies. We believe that everyone should have access to a wide range of comprehensive and affordable solutions. Pick the product you are interested in below, and expect a call-back from our partners.

Until next time.

The InsuranceFundi Team


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