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Q&A: Medical scheme membership A MEDICAL scheme is a non-profit entity controlled by a board of trustees. However, the administration of the scheme is undertaken by a profit-making private company, and it is here that conflicts of interest may arise between members of a scheme and shareholders of its administration company. For this reason, medical schemes are tightly regulated: they are governed by the Medical Schemes Act and regulation is enforced by the Council for Medical Schemes (CMS), which falls under the Department of Health. The following Q&A on medical scheme membership is an edited version of information available on the CMS website: Is membership of a medical scheme available to anyone? Yes, the open enrolment principle means that you can join any medical scheme of your choice. The exception is membership of restricted schemes, which have been established exclusively for members/staff of a particular employer, profession, trade, industry, calling, association or union. Can I belong to more than one medical scheme at the same time? No. You must ensure that your membership of a scheme is cancelled before enrolling with a new scheme. Can a minor be a member? A child can be registered as a dependant of a member or, if his or her parents are not members, as a principal member, provided that
This is an edited version of information available on the CMS website
FACT FILE
the eligibility criteria stated in the rules of the scheme. In terms of the Act, dependants are: l Your spouse or life partner; l Dependent children; l Other members of your immediate family for whom you are liable for care and support; or l Any other person who is allowed as a dependant under the rules of the scheme. A child under the age of 21 is a child dependant; a child over 21 is an adult dependant. Physically or mentally disabled people can be registered as child dependants if it is allowed in the rules of the particular scheme. If not, they can be registered as adult dependants. A third-generation dependant is the grandchild of the principal member. Most schemes allow these dependants to be added only if the grandparents have legally adopted the child or where a court of law has awarded guardianship to them.
the relevant contributions are paid on his or her behalf.
If I die, will my registered dependants still be covered? Yes, without any break in membership and provided contributions are paid. Such members are referred to as continuation members, and one of the dependants (usually the surviving spouse) will become the principal member. In the case of restricted medical schemes, no additional dependants will be allowed. For example, if the surviving spouse remarries, the new partner would not be eligible for membership.
May a medical scheme refuse to admit my dependant? No. A scheme may not refuse admission if the dependant meets
Go to www.medicalschemes.com for more information about the Council for Medical Schemes and its functions.
