5. Underwriting, Membership and Finance

1. Who qualifies as a dependant?

• Spouse (NOT an ex-spouse)
  
• Companion/Partner of principal member
  
• Dependent Children including adopted children, foster children and stepchildren.
  
• Brothers, sisters and parents if dependent on the principal member for family care and support.
  

2. What proof is required by the Scheme in respect of a dependant's reliance on the member?

• In the case of a spouse, a marriage certificate.
  
• In the case of companion, a sworn affidavit that the principal member and this dependant shared a communal household akin to a marriage.
  
• In the case of children and stepchildren: a birth certificate, and all legal documents in respect of adopted children) and a court order for a foster child.
  
• In respect of brothers, sisters and parents of the principal member, a completed amendment form which includes a sworn affidavit and a medical history questionnaire.
  

3. What is a late joiner penalty?

A late joiner penalty is an amount that may be added to an applicant/dependant's monthly contribution if that applicant/dependant joins a medical scheme late in life (after age 35). The penalty is calculated by using the number of years that an applicant/dependant had not been a member of a medical scheme(s) and converting it into a percentage of the monthly contribution.

The guidelines for determining the late joiner penalty percentages are available fron the Scheme.

4. Are all previous medical scheme memberships of a registered medical scheme taken into consideration when calculating a late joiner penalty?

Yes. That is why precise dates of previous medical scheme membership are required to determine an accurate late joiner penalty amount.

5. What proof of previous medical scheme(s) membership may be submitted?

• A certificate of membership
  
• Affidavit regarding previous medical scheme membership
  

6. What are waiting periods?

According to the Medical Schemes Act, waiting periods may be imposed on any new applicants/dependants. The two different waiting periods that may be imposed are:

• General waiting period of 3 months (may be placed on all applicants/dependants)
  
• Condition-specific waiting period of 12 months (may only be placed if a pre-existing medical condition exists)
  

The Act also specifies circumstances when a waiting period may not be imposed.

7. Why is more medical information frequently asked?

According to the Medical Schemes Act, 12 month condition-specific waiting periods may only be placed if an applicant/dependant received medical advice, a diagnosis was made or care/treatment had been received for a medical condition within the 12 months preceding an application for medical scheme membership. To determine this, more medical information is often required.

8. Are all benefits excluded during a waiting period?

Yes, except for Prescribed Minimum Benefits as stipulated by the Medical Schemes Act provided that those benefits are administered in a provincial hospital. If you were not a member/dependant of a medical scheme 90 days prior to your application, Prescribed Minimum Benefits may also be excluded.