Imperative to retain your medical scheme cover at this time

By: CompCare Medical Scheme

With South Africans officially in lockdown due to the COVID-19 pandemic, many people are concerned about their financial situation and are looking to tighten their belts. Josua Joubert, Chief Executive and Principal Officer of CompCare Medical Scheme, advises those who have medical scheme cover to nevertheless do their level best to retain their membership over this tumultuous time.

“In these uncertain times, none of us know whether we may need our hospital or other health benefits, and it has probably never been more important to belong to a medical scheme than it is right now,” says Joubert.

“Therefore we encourage medical scheme members, no matter whether they have a hospital plan, or more comprehensive cover with day-to-day benefits, to do their utmost to retain their membership, even though it may be difficult from a financial point of view at the present time,” he adds.

“Aside from providing cover for hospitalisation, medical scheme membership offers a number of additional benefits to assist in carrying you and your loved ones through these challenging times. Now is a good time to use these to full advantage to assist you in taking care of your physical and mental health.”

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

“At CompCare we have made a number of adjustments to our services at this time, including making provision for telephonic or video-call consultations with medical professionals, and thus avoiding the need for face-to-face consultations as far as possible to assist in reducing the possibility of the transmission of the virus. 

“We are also finding that there is a considerable demand for the telephonic counselling service that is offered to all CompCare members through our psychosocial benefit. This is assisting many to deal with the physical, mental and financial uncertainties that surround the pandemic. Provision can still be made for face-to-face counselling in more serious cases but here again we are encouraging the use of technology such as video-calls between therapist and client as far as possible.

“We understand only too well that the changing face of our world and our personal circumstances will take an emotional toll on many people and wish to remind our CompCare members that our telephonic psychosocial service is at hand to assist should they require it. This remains available to them 24/7/365 throughout the lockdown period and can be accessed toll-free on 0800 390 003.”

Joubert warns that cancelling, or allowing membership to lapse may have consequences, which all members should be aware of. These may apply even when re-joining a medical scheme, and could include the following:

  • Those who terminate their membership now may well be subjected to a waiting period and/or a late joiner penalty should they wish to re-join a medical scheme at a later stage.
  • The Medical Schemes Act stipulates that any break in medical scheme coverage of more than 90 days, entitles a medical scheme to impose a three-month general waiting period, as well as a 12-month condition specific waiting period, on the membership of an applicant. During this time, Prescribed Minimum Benefit (PMB) conditions will not be covered.
  •  The Act also states that if an applicant who is 35 or older when joining a medical scheme, has a break in coverage exceeding three consecutive months since 1 April 2001, their scheme may impose a late joiner penalty. This does not expire and the percentage calculated in terms of Regulation 13 will be added to your monthly contribution indefinitely.

“It is therefore important for members of any medical scheme to try to retain their membership as far as possible, so that they can avoid the possible imposition of waiting periods and late joiner penalties, which were put in place specifically to protect the reserves of medical schemes.”  

By law medical schemes cannot 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. Medical schemes must also operate as not-for-profit organisations.

“Given that all members pay the same contributions, it would be somewhat unfair towards members who have been 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,” explains Joubert.

“CompCare members can rest assured that the scheme will be at their side should they require it. Despite the uncertainties of this time, a few certainties remain, such as the knowledge that when we work together, we can more effectively tackle the COVID-19 pandemic,” concludes Joubert.

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