How You Can Ascertain Your Obligations in a Medical Scheme

If you are a member of a scheme, you are basically entitled to copies of the scheme financial statements, annual reports and copies of the scheme rules. Anyone has a right to join a medical scheme except if he has a restricted membership scheme such as trade, industry, employer or profession.

In terms of the Medical Schemes Act, there is no prospective member who cannot apply for a scheme membership through a medical broker. When a member dies, all the registered dependents will still be covered by the medical cover. If you choose not to continue with your membership, a notice stipulated in the rules must be compiled and given to the scheme.

While serving a notice of termination, you will be entitled to benefits until the last day provided you pay the contributions. Your employer will not be able to subsidize your contributions to the scheme since the medical act does not in any case address such conditions. There are no copayments, restrictions, exclusions and waiting periods to prescribed minimum benefits.

New Applicants for Medical Schemes

For applicants who have never been in a medical scheme, there is a high chance that waiting periods will be imposed. Within 30 days of termination, the scheme will provide you with a certificate that states the period of cover and you will be required to provide a sworn affidavit of your previous unsuccessful membership.

If you choose to join a medical scheme late in your life, you will be imposed with a late joiner penalty. If in case you are not satisfied with the decision from your registrar, you have the right to lodge an appeal with the board and you will have to pay a prescribed fee for this. You should present the appeal to the council three months after decision was made. You might find out that you are not aware of a one-time medical prescription and a chronic medication. Have a look at your finances and determine whether the medical scheme fits your budget.

Obligations in a Medical SchemeHealth Status and Medical Scheme Membership

Also, you should determine your specific needs such as: if you are a healthy individual and young and single, you should look for a medical scheme that will cover for unexpected hospital bills.  Discover your immediate needs in case of an unforeseen emergency. There is no council entitled to award costs after consideration of an appeal.

Following the month when the service was rendered, you should submit your account not later than the fourth day at the start of the month. When you terminate your medical scheme membership without joining another scheme, your credit balance in your membership account can be withdrawn in cash. The medical act regulates payment of claims.

One at a Time

You should keep in mind that it is illegal to belong to more than one scheme at one time. With assistance from a guardian or parent, a minor can easily become a member of the scheme provided he pays the required contribution. If in case you suffer undue hardship, the medical scheme can give you Gratia payment.