How You Can Ascertain Your Obligations in a Medical Scheme

There are definite member 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. However, not if it is 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 scheme membership. When a member dies, all the dependents will still have medical cover. If you choose not to continue with your membership,you must complete a notice and give it to the scheme.

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

New Applicants for Medical Schemes

There is another member obligations in a medical scheme. Perhaps you have never been in a medical scheme. In that case, there is a high chance that waiting period and later joiner penalties will be imposed. Within 30 days of termination, the scheme will provide you with a certificate that states the period of cover. You must then 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. Perhaps you are not satisfied with the decision from your registrar. In that case you have the right to lodge an appeal with the board. A fee is payable. 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.

Obligations in a Medical Scheme – 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 a Gratia payment.


All info was correct at time of publishing