Selection of scheme and benefit plans/options
- Ensure that the scheme is duly registered in terms of the Medical Schemes Act 131 of 1998. The names, addresses and telephone numbers of all registered schemes are published on the website of the Council for Medical Schemes. The address is: http://www.medicalschemes.com/Consumer_Assistance/RegSchemes.aspx
- 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.
- Request information about benefits, contributions, limitations and exclusions from your selected schemes.
- 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 Council and/or verify the broker accreditation status on: http://www.medicalschemes.com/Consumer_Assistance/FindBroker.aspx.
- 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
Membership, contributions and benefits
- Only in respect of the cover provided. Different benefit options/plans are priced differently depending on the level of cover afforded.
- If the rules of the scheme so provide, children may be charged a reduced contribution.
Minimum benefits, waiting periods and late joiner penalty
- Late joiner penalty
- Waiting periods
- Prescribed minimum benefits other than specified in Q28
- A child dependant born during the period of membership
- A member moving between benefit options unless he has to complete the remaining period of previously imposed waiting periods.
- When an individual has to involuntarily transfer to another scheme due to a change of employment.
- In instances where an employer changes the medical scheme of hisemployees with effect from the beginning of the financial year.
- General waiting period of up to three months.
- Condition-specific waiting period of up to 12 months.
- the service was not available from the designated service provider or would not be provided without unreasonable delay;
- immediate medical or surgical treatment for 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
- There was no designated service provider within reasonable proximity to the beneficiary's ordinary place of business or personal residence.