MATERIAL NON-DISCLOSURE CAN COST YOU DEARLY
When you fill in your medical scheme application form, be aware that there can be serious consequences for you if you fail to declare “material information” about your medical history or that of your dependants.
Material information is any information the scheme requests that could be used to assess the risk of taking you on as a member.
Medical schemes have the right, in terms of the Medical Schemes Act, to cancel or suspend your membership or that of any of your dependants on the grounds of the non-disclosure of material information.
If you fail to disclose all the information the scheme asks for on its application form, you will prevent it from being able to assess its risks and possibly from imposing conditionspecific waiting periods.
You cannot be made to pay more in contributions if you have health problems. The worst that can happen is that the 12-month condition-specific waiting period will be imposed, and this will apply only if you have left more than 90 days between changing schemes or if you have not belonged to a scheme for more than two years.
The financial consequences of your membership being terminated and your claims being denied may far outweigh those of this waiting period.
Schemes check for non-disclosure by checking the hospital admissions, chronic medication applications or other big claims submitted by new members. Then they will check if you declared the condition and your medical history.
In many cases, schemes have discovered non-disclosure when a member or dependant has been hospitalised for something related to a pre-existing condition. As a result, they have terminated these members’ memberships, leaving them with expensive hospital bills.
The Council for Medical Schemes Appeal Committee has even upheld the right of schemes to terminate membership where members have claimed their broker was to blame for supplying the incorrect information.
The committee has taken the view that if you sign the application form and confirm you have read the form and warranted that the information on it was correct, you must bear responsibility for your conduct.
Do not rely on a medical scheme broker to fill in your medical history on an application form. Instead, fill in the form yourself or supply your broker with a list of your and your dependants’ medical conditions, and then check that the conditions have been recorded correctly on the application form before you sign it.