MA­TE­RIAL NON-DIS­CLO­SURE CAN COST YOU DEARLY

Weekend Argus (Saturday Edition) - - GOOD WEEKEND -

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.

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