Medical Aid Short Paid or Not Paid By Employer

Having a company medical aid is a benefit that not all workers are fortunate to have. It is not mandatory but may employers see it as an incentive to employees above and beyond the monthly salary and year end bonus. Some companies pay 33% (one-third) of the monthly contribution while others may be generous enough to fork out as much as 66% (two-thirds) of the premium. It also takes some of the hassle out of the administrative side of things for workers, as medical aid premiums are deducted from the salary and paid by the employer to the medical scheme. But what if you employer does not pay your medical aid premium in full this month, or has missed the payment to the scheme altogether?

Reasons for Payment Errors by Employers

Errors do happen and before you panic, it is important that you speak to the HR department in the company, or directly to somebody in senior management in the company. Medical aid contributions need to be paid at the beginning of every month. Forward paying means that you are covered for the month when you have paid at the beginning of the month. No payment means no cover for the month. When your employer has short paid or missed payment to your medical scheme, you essentially have a problem with the cover for that month, and for any months thereafter until any contributions in arrears is settled in full.

Before you try to guess the reasons for this payment issue on the part of your employer, it is best to first get written confirmation from your medical scheme that they have been short paid or not paid at all. Medical schemes are known to make errors and your employer may not take to it kindly if you make claims without written proof. Also speak to co-workers and have them call the scheme to confirm that there was a payment problem. Your employer could be entirely unaware of the issue and there may have just been an error with the payment process or somebody in the administrative and accounting side of the company could have bungled up the payments.

Of course there is also the concern that your employer may be in a dire financial situation and is unable to make these payments despite deducting your share from the salary. Speak to your employer. Find out the reason why this may have happened if it was not an error on the part of your scheme. Do not make assumptions, do not try to sow discord among your fellow workers and most importantly do not lay unfounded accusations. It could cost you your job in the long run.

Solution for Short or Missed Payment

Notify your employer immediately once you find that the contributions have been short paid or not at all. An immediate payment by your employer will instantly remedy the situation. If your employer is delaying then you need to understand the consequences of this payment issue. Firstly your medical aid will not be terminated immediately. Instead the scheme suspends your membership. No claims will be paid for the month(s) when the premium was short paid. Once all the outstanding premiums have been settled in full, then your medical scheme will release payments to your doctor, hospital and other service providers.

If there has been no payment of contributions for more than 3 months, the medical scheme can terminate your membership. All accounts that have been submitted by medical providers will then not be paid at all if it falls within the period from when premiums were stopped. You as the patient will then be liable to settle these bills directly with the doctor and other practitioners in cash. Essentially when your medical aid is suspended it just means that it is frozen until the payment issue is resolved. Try not to use your medical aid for your healthcare needs. You could end up with massive bills in the end that you need to pay yourself.

As for the issue with your employer, you need to gather your co-workers and speak to the HR department or to your boss directly if it is a small to medium enterprise (SME). If this does not yield any results then you should speak to the union representative or seek other legal avenues. Since your employment contract or offer for employment clearly indicates that the employer will take responsibility for medical aid contributions, at least in part, you have some recourse. But if not, then the matter is entirely in your hands. Your medical scheme, doctor or hospital cannot resolve this issue on your behalf and it is therefore advisable that you have cash in hand to settle your bills on your own.