Management and Function of a Medical Scheme

What is the function of a medical scheme’s management?

The boards of trustees are normally appointed from among members. They manages the affairs of a medical scheme. Individuals chosen must be proper and fit when performing their duties. They must ensure 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 be held accountable for all losses. The medical scheme does not have the right to determine contributions of an individual who has high claims.

Function of a Medical Scheme

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 various conditions. These include cancer, emergency services, organ transplant, HIV AIDS treatment, artificial limbs, dental surgery, ambulance and other medical appliances.

Before joining a scheme, check if it has insufficient medical cover when more than three dependents are in an accident.

Function of a Medical Scheme Regarding Daily Expenses

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 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.

Function of a Medical Scheme After Joining

As a member, you may request to copies of your financial statements, annual reports and the rules of 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 get 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’s registration in terms of the medical act.

If you are employing the services of an agent, you should ensure that the agent is legitimate according to the Council. Ask for proof of accreditation with the medical scheme. 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.


All info was correct at time of publishing