Q2. How may a member ascertain what his obligations to the scheme are and what his rights, benefits contributions and limitations or benefits are from time to time?
2. The list is furthermore published annually in the Government Gazette for general information. The office of the Registrar will also provide you with information on registered schemes.
3. Request information about the benefits, contributions, limitations and exclusions from your selected schemes.
4. If you do employ the services of an agent, broker (intermediary), ensure that he /she has been accredited by the Council for Medical Schemes and that your selection of scheme is based on informed consent. To ascertain whether a broker has been accredited, prospective members should insist that brokers produce proof of accreditation with the Council and/or verify the broker accreditation status on: http://www.medicalschemes.com/Consumer_Assistance/FindBroker.aspx.
5. Request the latest financial statements and annual report of the scheme to avail yourself of their financial position. These reports are available in the Council’s Annual Report. To view these Annual Reports, go to the following address on our website: http://www.medicalschemes.com/Publications/Publications.aspx?catid=11
Q16. Is my scheme entitled to cancel my membership when the employer fails to pay the membership fees?
Q17. Can my scheme terminate my membership of the scheme in the case of 1. retrenchment, 2. redundancy or 3. retirement?
Q19. May medical schemes determine the contributions of retirees on their income immediately prior to retirement as a subsequent deemed income or salary?
Q20. May a medical scheme determine contributions on the basis of individual high claims or provide for discounted or preferred rates in respect of a particular group of members/clients for whatever reason?
2. If the rules of the scheme so provide, children may be charged a reduced contribution.
Q24. May a medical scheme request pre-authorisation or second opinions in respect of certain benefits?
1. The service was not available from the designated service provider or would not be provided without unreasonable delay;
2. Immediate medical or surgical treatment for the prescribed minimum benefit condition was required under circumstances or at locations which reasonably precluded the beneficiary from obtaining such treatment from a designated service provider; or
3. There was no designated service provider within reasonable proximity to the beneficiary’s ordinary place of business or personal residence.
1. General waiting period of up to three months.
2. Condition-specific waiting period of up to 12 months.
1. Prescribed minimum benefits other than specified in Q28.
2. A child dependant born during the period of membership.
3. A member moving between benefit options unless he has to complete the remaining period of previously imposed waiting periods.
4. When an individual has to involuntarily transfer to another scheme due to a change of employment.
5. In instances where an employer changes the medical scheme of his employees with effect from the beginning of the financial year.
2. Waiting periods