Q1. When did the Medical Schemes Act come into operation?
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?
Q3. How do I as an individual select an appropriate medical scheme?
Q4. How do I know which benefit option to select?
Q5. What is a co – payment?
Q6. Is membership of a medical scheme available to any person?
Q8. Can a minor become a member?
Q9. May a medical scheme refuse to admit my dependant?
Q10. Must a prospective member apply for membership of a medical scheme through a broker?
Q11. If a member dies, will his registered dependants still be covered?
Q12. Must I give notice to the scheme in the event that I wish to terminate membership?
Q13. Am I entitled to benefits while serving notice of termination?
Q14. Must my employer subsidise my contributions to the medical scheme?
Q15. What role does my employer play in my relationship with my scheme?
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?
Q18. May pensioners’ contributions be less than that of other members?
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?
Q21. If I do not claim from my medical scheme, may I receive a no-claim bonus or rebate?
Q22. On what basis may contributions vary?
Q23. May my medical scheme call upon me for increased contributions with retrospective effect?
Q24. May a medical scheme request pre-authorisation or second opinions in respect of certain benefits?
Q25. What can I do if I am not satisfied with my current benefit option?
Q26. What are prescribed minimum benefits (PMBs)?
Q27. What is a designated service provider (DSP?)
Q28. To what extent are the prescribed minimum benefits restricted?
Q29. What constitutes the involuntary obtaining of services in respect of the PMBs from non – DSPs?
Q30. What are the types of waiting periods?
Q31. What does a waiting period mean?
Q32. When do waiting periods not apply?
Q33. How can I prove to a new scheme that I was a member of another scheme?
Q34. What is a late joiner penalty?
Q36. Can a medical scheme impose a condition – specific waiting period on pregnancy?
Q37. Where do I complain if claims are not paid timeously or when I am dissatisfied with a decision taken by the scheme?
Q39. What remedies are available if I am not satisfied with the outcome of Q37?
Q40. What recourse do I have if I am not satisfied with the decision of the Registrar?
Q41. How does one present such an appeal to Council?
Q43. Within what period of time must my account for services or claim reach my medical scheme?
Q44. May credit balances in my personal savings account be withdrawn in cash?
Q45. May contributions be paid out of my savings account?
Q47. How do I know whether or not my scheme has paid and what amount has been paid in respect of a claim?
Q48. Within what period of time must the scheme pay my claim?
Q49. What is an ex GRATIA payment and do I have a right to such benefits?
Q50. What is National Health Reference Price List (NHRPL)?
Q51. Is a provider of a health care service entitled to charge more than the fees determined by medical schemes / the tariff specified in the NHRPL?
Q52. Who manages the affairs of a medical scheme?
Q53. How do medical schemes function?
Q54. May I participate in the operation of my scheme?
Q55. Are insurance products regulated by the Medical Schemes Act?
Q56. What certainty does a member have that the benefits offered by his scheme are guaranteed?
Q57. As members of a group, may we leave the medical scheme to which we belong and claim our pro rata portion of the reserves?
Q58. Can a medical scheme change its rules and thereby move the goal post?
Q59. When may my scheme terminate or suspend my membership?