Management and Function of a Medical Scheme

The boards of trustees who are normally appointed from the members are ones who manages the affairs of a medical scheme. Individuals chose must be proper and fit when performing their duties thus making sure that the interests of all members are protected and the scheme is properly administered. If in case they are reckless or are guilty of misconduct, they will definitely be held accountable for all losses incurred. The medical scheme does not have the right to determine contributions of an individual who has high claims.

Function of a Medical Scheme

The medical scheme has the right to determine contributions of retirees prior to retirement. Some hospital plans and medical schemes have specific regulations on treatment of cancer, emergency services, organ transplant, HIV AIDS treatment, artificial limbs, dental surgery, ambulance and other medical appliances. Before joining a scheme, you should check if it has low limits or insufficient medical cover when more than three dependents are involved in an accident. You should add up your daily medical expenses to check if the price can cancel out the difference between medical scheme and hospital plan. Some medical plan stipulates that you must use a specific network which is fine and can bring a pleasant surprise to you. Before joining your preferred medical scheme, you should make sure that you have resigned from your current medical scheme. However, this does not mean that you have to stay without a medical cover. You should contact your current medical provider in order to let them know that you are resigning from the scheme. Do it in writing while finding out when your cover will terminate. Make sure that immediately your old medical plan terminates, your new medical plan commence. After joining a new scheme, you will be entitled on request to copies of your financial statements, annual reports and the rules that are put in place in the scheme. You will be able to know the obligations of your new scheme, the contributions, the rights, the benefits and the limitations. In terms of medical scheme act, you will be given a written notice regarding any condition that affects your scheme membership. It is possible for you to prove to your new medical scheme that you were a member of another scheme by providing your membership certificate that states the period of cover. In order to make the right selection, you should make sure that the scheme is registered in terms of the medical act.

If you are employing the services of an agent, you should ensure that the agent is registered by the medical council scheme. Ask for proof of accredited on with the medical scheme in order to ascertain that the agent is accredited. To avail yourself in a financial position, you should request for the latest annual report and financial statements of the medical scheme. Select your benefit option according to your finances and according to your healthcare needs. If the medical scheme has failed to resolve the members’ issue, the Council for Medical Schemes should be contacted.