The status of your medical aid cover is an important factor to consider when you need to access healthcare services. If you have not been up to date with payments then it is important to speak to your medical scheme to verify whether your membership is still active. It is possible that your membership has been suspended or even terminated and you may not be aware of it. Sometimes the attempts by your medical scheme to contact you has failed and your membership is no longer active.
What does active member mean?
An active member means that a specific person (main member, adult or child dependant) is still covered by the medical scheme. The medical aid premiums are fully paid up and the dependant has not been removed by the main member or is not excluded from cover due to some contravention of the scheme rules. The active member can therefore use the medical aid or claim back from the medical aid for necessary health care costs.
It is important to note that even if one member is still active on the cover, it does not necessarily apply to all members. There are cases where a dependant is removed from the cover by the main member and the dependant is not aware of this termination of cover. Verification with the scheme is simple – it can be done over the phone but with many medical schemes option for online channels, membership can be verified on the scheme’s website or app.
What does suspended membership mean?
A suspended membership means that the medical aid cover is inactive. It is usually suspended when the premiums are not up to date. Suspension is a temporary state – the membership can be reactivated once all outstanding premiums are settled in full. This has to be arranged by the main member who may have to do an EFT to the medical scheme or agree to be debited for all outstanding amounts.
When the membership is suspended then any member, be it the main member or the adult and child dependants, cannot use the cover to pay for healthcare costs. Medical services providers may also hold the patient liable for bills since the cover is inactive. A suspended medical aid membership will remain in the suspended stage for up to 3 months (90 days), after which the membership is terminated.
What does terminated membership mean?
Terminated membership means that the entire membership is inactive and cannot be restored. This usually occurs when medical premiums have not been up to date for at least 3 months. However, it can also occur when the main member and dependants move from one scheme to another or opt to cancel the membership by following the proper procedures.
Whatever the reason for a terminated membership, the fact is that none of the members can use the cover to pay for healthcare services. They also cannot claim back any healthcare costs from the medical aid when they pay cash for treatments. When only one or two members have been terminated, then it is usually at the request of the main member. Cover ends on a specified date.
Reinstating Medical Aid Cover
Since a terminated membership cannot be restored, members will have to reapply for medical aid cover. This can be done with the scheme in question, although the scheme will require that any outstanding bills are paid in full. Alternatively, members can opt for medical aid cover with another scheme. However, the previous scheme should be covered in full or can opt to take legal action to recover outstanding premiums.
A main member can reinstate suspended membership by taking the necessary steps like settling outstanding premiums. If this is done within 90 days from the day the membership was suspended, there cover can continue thereafter without any further interruption. There is no need to join the scheme or any other scheme again as a new member. Waiting periods that are usually applied to new members will not be applicable.
However, once medical aid membership is terminated then the main member or any other adult dependant has to reapply for membership. Once approved, waiting periods will apply once again. There is a 90 day general waiting periods and a 12 month waiting period for pre-existing conditions. It is therefore important to not led medical aid membership lapse as it can affect future cover.