1. Membership

1.1 Who qualifies as a dependant of a member?

• Spouse (not an ex-spouse)
  
• Companion of principal member
  
• Children
  
• Brothers, sisters and parents if dependent on the principal member for care and support.
  

1.2 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 a common-law spouse, an affidavit.
  
• In the case of a companion, a sworn affidavit that the principal member and this dependant share a communal household akin to marriage.
  
• In the case of children:
  – legal documents in respect of adoption (in the case of an adopted child),
  – a court order for a foster child.
  
• In respect of brothers, sisters and parents of the principal member, a sworn affidavit confirming the relationship to the principal member and stating that the family member is financially
  dependent on the principal member for care and support, as determined by a Court of Law.

1.3 How do I add a new dependant to my existing membership?
By completing an amendment form, which can be obtained from the Scheme or downloaded from the website (www.selfmed.co.za).
Fax the completed amendment form to 0860 288 363. Should you have any enquiries regarding your application, please contact us on 0860 787 372.

1.4 What happens in the event of the death of the principal member?
The Scheme will notify the eldest dependant of his/her right to continue with the membership, with the status of the other dependants remaining unchanged, provided that the Scheme receives a copy of the death certificate. Unless such person informs the Board of his intention not to become a member he will be admitted as a member to the Scheme.
Bank details should be furnished to the Scheme to avoid any interruption in the payment of contributions.

1.5 When will the Scheme have the right to cancel my membership or that of any of my dependants?

If you or any of your dependants:

• joined another scheme and neglected to give the Scheme one month’s advance notice, in which case no more than two months’
  contributions will be refunded;
  
• provide false information, or fail to disclose material information when applying for registration;
  
• provide false information upon submission of a claim, submit a fraudulent claim, or intentionally allow a service provider to do so
  on your behalf;
  
• allow any other person to use your membership card;
  
• without a good explanation, neglect to inform the Scheme that it has paid for services or supplies that were not delivered or
  received;
  
• commit any other fraudulent act;
  
• fail to pay contributions within 28 days;
  
• fail to repay an advance within 28 days.
  
  

1.6 When am I entitled to benefits?

You are entitled to benefits from the inception date of your membership, provided that no general waiting period or condition-specific waiting period
is applicable.

1.7 Waiting period

1.7.1 What is a general waiting period?
The Scheme may impose a general waiting period of three months on all benefits in respect of all new applicants and dependants who:

• Have never belonged to a medical scheme;
  and/or
  
• Have not belonged to a medical scheme for 90 days or more, prior to joining the current scheme; and/or
  
• Were members of another medical scheme for a period of more than 2 years and have not had a break of 90 days or more between leaving the previous scheme and joining the new scheme.
  

Please note that a certificate of previous membership may be required.

1.7.1.1 Can I opt to make a payment in lieu of this waiting period, in order to have it waived?
No.

1.7.2 What is a condition-specific waiting period?
The Scheme may further impose a condition-specific waiting period of up to 12 months from the inception date of your membership, in respect of any pre-existing condition, in respect of any beneficiaries who:

• Have never belonged to medical scheme
  
• Have not belonged to a medical scheme for 90 days or more, prior to joining the current scheme
• Have belonged to a previous medical scheme for a period of less than 2 years and have not had a break of 90 days or more between leaving the previous scheme and joining the new scheme.
  
  

Please note that a certificate of previous membership and medical report may be required.

1.7.3 No waiting periods will be imposed on:

• A beneficiary changing option within a scheme
  
• A child dependant born during the period of
  membership.

1.8 Inception date

1.8.1 What is an inception date?
This is the date of registration of membership for both you and your dependants. Your contributions are payable from your inception date.

1.8.2 What is the inception date in respect of dependants?

• If the application is received within 30 days of the new dependant becoming eligible for registration (e.g. through marriage, birth or
  adoption), the inception date will be the date on which the dependant became eligible.
  
• If the application is received after 30 days of the new dependant becoming eligible for registration, the inception date will be the 1st of the month following the one in which the application was received,

OR the 1st of the month following the one in which the Scheme receives all the information it may need in respect of such application.

1.8.3 Will benefits be pro rata?
Yes, if membership or dependant membership commences after 1 January. This is applicable to all benefits that are subject to an annual limit.

1.9 When do my dependants become entitled to benefits?
Your dependants are entitled to benefits from the inception date, unless a waiting period is applicable.