Medical scheme membership, now more important than ever

By: CompCare Medcial Scheme

 

“It has never been more important to belong to a medical scheme than it is right now. We encourage members, no matter whether they have a hospital plan or more comprehensive benefit plan, to do their utmost to retain their membership, even though it may be difficult financially,” says Josua Joubert, Chief Executive and Principal Officer of CompCare Medical Scheme.

“Aside from providing cover for hospitalisation, medical scheme membership offers many additional benefits to carry you and your loved ones through these challenging times.”

Joubert says that all members, including those with only a hospital plan, should remember that medical schemes are legally required to provide cover for all prescribed minimum benefits (PMBs), a set of defined benefits for 25 chronic medical conditions. This ensures that members have access to minimum health services, no matter what benefit option they have chosen.

“At CompCare we have added enhancements to our services, including making provision for telephonic or video-call consultations with doctors for those who cannot get to a doctor. We have seen an increased demand for our telephonic counselling service offered to members through our psychosocial benefit. This is assisting many in dealing with the physical, mental and financial uncertainties surrounding the pandemic.

“We fully understand that the changing face of our world and our personal circumstances are taking an emotional toll on many and wish to remind members that our 24/7/365 psychosocial service is at hand toll-free on 0800 390 003 for those who may need it.”

Joubert cautions that cancelling, or allowing membership to lapse, may have consequences, even when re-joining a medical scheme. Consequences include being subjected to a waiting period and/or a late joiner penalty when re-joining at a later stage –

  • the Medical Schemes Act stipulates that any break in coverage of more than 90 days, entitles a scheme to impose a three-month general waiting period and a 12-month condition specific waiting period, on the membership of an applicant. During this time PMB conditions will also not be covered.
  • the Act further states that if an applicant who is 35 or older when joining a medical scheme, has a break in coverage exceeding three consecutive months their scheme may impose a late joiner penalty. As it does not expire, the percentage calculated will be added to the monthly contribution indefinitely.

“It is therefore important to retain your membership so that you can avoid the possible imposition of waiting periods and late joiner penalties, which were put in place to protect the reserves of medical schemes.

“Medical schemes, which are not-for-profit organisations, can by law not charge different premiums for members based on their health status or age. Contributions can only vary based on a member’s income and the number of dependants registered on the membership.

“Given that all members pay the same contributions, it would be unfair to members contributing to the fund for years, if an applicant who only just joined the scheme were to receive exactly the same benefits for the same contribution, without being impacted by waiting periods or late joiner penalties,” concludes Joubert.