YOU will be shooting yourself in the foot if you do not disclose your and your dependents' health status when you join a medical aid scheme.
YOU will be shooting yourself in the foot if you do not disclose your and your dependents' health status when you join a medical aid scheme.
It is vital that you be honest or your medical aid will not pay your health bills.
Nomfundo Ntshangase has learnt this the hard way. She said she forgot to tell Discovery Health that her husband was a diabetic because when she was with her previous medical aid her husband had not been diagnosed. When she joined Discovery Health this year her husband had not been on any medication.
"It was only in October last year that he discovered he was diabetic," Ntshangase said.
The company is now reclaiming all medical costs they had paid.
Ntshangase's problem started last month when her husband Vusi had a severe headache and was taken to the Morningside Clinic.
Tests revealed that his sugar levels were sky high. He had to be hospitalised. They now owe Discovery Health R12000 and have to repay R35000 for hospitalisation, Ntshangase said.
Allim Milazi of Discovery Health said there was no excuse for not disclosing one's medical condition.
Milazi said they cancelled Ntshangase's membership because she had not disclosed her husband's condition when she joined.
"Our application form makes it clear that members must give true and accurate information about their and their dependants' health.
"It also states that we may cancel membership if there is non-disclosure," Milazi said.
He said their reason for requiring detailed medical information is that they underwrite membership. He said regulations allowed medical schemes to apply certain waiting periods before new members and dependants can claim. He said the purpose of underwriting was to help protect both the medical scheme and members against risk.
He said had they known Vusi Ntshangase was a diabetic they would have underwritten the membership differently and offered different terms.
"Non-disclosure is a major concern for medical schemes and members as it drives up costs and is often associated with abuse and even fraud," Milazi said.
"We regret that we cannot make an exception in this case," he said.
Milazi said Discovery Health's application form terms and conditions are simple and easy to read. They are written in plain English to ensure that people understand exactly what they are signing, Milazi said.
Consumer Line could not find any clause that said Discovery Health may reclaim any costs they had paid on behalf of members.
When giving information, this section reads: "You must give us true, correct and complete information.
"To consider your application for membership, the scheme must learn more about you and those you apply for.
"Information about you and those you apply for must be true, correct and complete.
"This includes the details you give in this application form and in your future dealings with us.
"It is important that you tell us about any medical condition, symptom or illness relating to you or those you apply for, even if you do not consider it relevant to your application.
"We may ask those you apply for who are 21 and older for information and it will be treated as if we had asked you in your role as the main member."
It further states the scheme may cancel membership immediately and keep any contributions if the applicant does not give information relevant to the application, give information that is not true, correct and complete or do not reveal any relevant changes (including about health and the health of dependents) between the day they sign the document and the day the cover starts.
At the time of publication, Milazi had not explained why Ntshangase should pay back the money Discovery Health had paid for her.
Reveal every detail
YOU will be shooting yourself in the foot if you do not disclose your and your dependents' health status when you join a medical aid scheme.
YOU will be shooting yourself in the foot if you do not disclose your and your dependents' health status when you join a medical aid scheme.
It is vital that you be honest or your medical aid will not pay your health bills.
Nomfundo Ntshangase has learnt this the hard way. She said she forgot to tell Discovery Health that her husband was a diabetic because when she was with her previous medical aid her husband had not been diagnosed. When she joined Discovery Health this year her husband had not been on any medication.
"It was only in October last year that he discovered he was diabetic," Ntshangase said.
The company is now reclaiming all medical costs they had paid.
Ntshangase's problem started last month when her husband Vusi had a severe headache and was taken to the Morningside Clinic.
Tests revealed that his sugar levels were sky high. He had to be hospitalised. They now owe Discovery Health R12000 and have to repay R35000 for hospitalisation, Ntshangase said.
Allim Milazi of Discovery Health said there was no excuse for not disclosing one's medical condition.
Milazi said they cancelled Ntshangase's membership because she had not disclosed her husband's condition when she joined.
"Our application form makes it clear that members must give true and accurate information about their and their dependants' health.
"It also states that we may cancel membership if there is non-disclosure," Milazi said.
He said their reason for requiring detailed medical information is that they underwrite membership. He said regulations allowed medical schemes to apply certain waiting periods before new members and dependants can claim. He said the purpose of underwriting was to help protect both the medical scheme and members against risk.
He said had they known Vusi Ntshangase was a diabetic they would have underwritten the membership differently and offered different terms.
"Non-disclosure is a major concern for medical schemes and members as it drives up costs and is often associated with abuse and even fraud," Milazi said.
"We regret that we cannot make an exception in this case," he said.
Milazi said Discovery Health's application form terms and conditions are simple and easy to read. They are written in plain English to ensure that people understand exactly what they are signing, Milazi said.
Consumer Line could not find any clause that said Discovery Health may reclaim any costs they had paid on behalf of members.
When giving information, this section reads: "You must give us true, correct and complete information.
"To consider your application for membership, the scheme must learn more about you and those you apply for.
"Information about you and those you apply for must be true, correct and complete.
"This includes the details you give in this application form and in your future dealings with us.
"It is important that you tell us about any medical condition, symptom or illness relating to you or those you apply for, even if you do not consider it relevant to your application.
"We may ask those you apply for who are 21 and older for information and it will be treated as if we had asked you in your role as the main member."
It further states the scheme may cancel membership immediately and keep any contributions if the applicant does not give information relevant to the application, give information that is not true, correct and complete or do not reveal any relevant changes (including about health and the health of dependents) between the day they sign the document and the day the cover starts.
At the time of publication, Milazi had not explained why Ntshangase should pay back the money Discovery Health had paid for her.
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