What the Medical Schemes Act Means to You
The Medical Schemes Act 1998 (Act 131 of 1998) came into being on the first of February, 1999. This is the law regulating all of South Africa’s medical schemes, whether open to everyone or restricted to various employer groups. The regulations pertaining to the Act were published in the Government Gazette No 20556 of 20 October 1999. They took effect on 1 November 1999 and 1 January 2000 respectively.
Member obligations and rights in terms of the scheme
Any member of a medical aid scheme may request copies of the scheme’s rules, annual reports and financial statements although a small fee may be paid for getting the documents. When a person is accepted as a member of a medical aid scheme, the relevant scheme must supply the member with a summary of the registered scheme rules. These include the rights and obligations of the member as well as the scheme, with details about all the benefit options and member contributions.
Top 5 Tips for Choosing hospital plans or comprehensive medical aid cover
• Preferably join a scheme that is registered in terms of the Medical Schemes Act 131 of 1998. You can find a full list of the schemes on this website here. Contact the Council for Medical Schemes if you are not sure of a scheme’s status.
• When investigating a scheme, ask for information about benefits, contributions, limitations and exclusions from the particular schemes that interest you.
• Should you be using a broker (an intermediary between the medical aid scheme and yourself) make sure that the agent has been accredited by the Council for Medical Schemes (CMS). He or she should be able to supply proof of this. Ensure that you are not sold something based on the broker’s preferences rather than your own requirements. If you need a broker you can find one here: http://www.medicalschemes.com/Consumer_Assistance/FindBroker.aspx.
• The only truly intelligent way to assess a medical scheme is to look at the latest
financial statements and annual report of the medical aid of your choice to
get a bird’s eye view of their financial
position. The annual reports are available on the CMS website: http://www.medicalschemes.com/Publication
Which option to select from a medical aid
Once you have settled on a medical aid you will need to pick the right option. Make sure you understand the various benefit options in terms of what they offer. Assess how each one applies to the health care needs or you and your family.
Fortunately the regulations arising from the Medical Schemes Act require schemes to disclose fully all information relating to the benefits accruing to each option. Get hold of the rules of the scheme, or at least a summary, to ensure you make a sensible choice.