Gap in Medical Cover Claims a Life

Millions of South Africans don’t have medical cover. And for the many that do, there are things about it that are complex but imperative to know.

If you have medical cover, you have to understand the options, what’s available and the scope of the medical cover. Sometimes, because of lack of knowledge about medical cover, things can go terribly wrong when you miss paying an instalment.

For many not having medical cover can be the end of the world, but it needn’t be. Most medical aid providers have a protocol in place, so that if you do happen to miss your premium, they attempt another debit order deduction 15 days later. Others take the missed payment off the next month, so that a double payment goes off.

The Ultimate Price for Misunderstandings

For senior medical aid members with retirement in mind should consider how all this will work out for them. For some people it can have dire consequences if you fail to make provision for retirement and medical aid.

Look at Mr ‘Al’ for instance, who recently died because of misunderstandings.  He had a break in Medical Covermembership when he took ill-health retirement after serving in the police force for 24 years.

Prior to leaving the police, he completed all the necessary forms. He was sure that he would still receive his medical scheme subsidy. It was important for him to do this as he wasn’t the only one on his medical scheme plan. His wife and children also had medical cover on the same plan.

However his pension was still being finalised when he experienced renal failure and had to go to hospital, spending a month there and incurring massive medical bills to the tune of R277 000.

Polmed told him that because his medical aid premiums were in arrears, he would have to first make a contribution of R9 300. Otherwise they would cancel his medical aid membership and he would have to pay the R277 000 himself. Polmed would reinstate his membership once they had finalised his pension and subsidy benefits.

Retirement funds can take a number of weeks to finalise and pay out and when you retire and your salary stops, you will have to pay your medical scheme contributions. This can create a host of problems,

Keeping Up Your Medical Cover Contributions Imperative

Members of Polmed for instance, get an annual subsidy which helps them with keeping up with their contributions while their retirement issues finalise. Fortunately in Mr ‘Als’ case, membership was reinstated and they GEMS settled the huge hospital bill that would have been his wife’s lot as he had unfortunately passed away.

Meanwhile GEMS has now agreed to assist members to keep their membership when they go on retirement. They’ll make sure members receive the subsidy for their contributions on retirement- or ill-health retirement.

The medical scheme GEMS will identify members going on retirement 6 months before they leave and encourage them to get their paperwork in order to ensure that unlike Mr ‘Al’, they don’t face a time where they aren’t getting an income and they also don’t have medical aid cover.

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All info was correct at time of publishing