RB
Rosalyn B

1 reviews | Active since Dec 2010

06 May 2016, 13:24

On medical aid all my life (no breaks) and imposed with a 3 month waiting period - is this even legal?

I belonged to Discovery for 7.5 years on Classic Comprehensive - the second highest medical aid cover.When employed by Liberty in August 2014 I was required to change.I resigned from Liberty in 2015 but remained with Liberty Health on a private health plan.I have been on medical aid ALL my life and NEVER had a break in medical cover.I app**** to rejoin Discovery Health on 26 April 2016 (not realising that it took 7 working days for my application to get processed ( I thought since I had been at Discovery before and they had my medical history that it would be within 2 to 3 working days (I supp**** them with my previous number for their convenience and to expedite the process). My application has one chronic condition (treated for 25 years and previously known to and paid for by Discovery). NO OTHER conditions (thankfully) have occurred in the interim period.Since Friday 29 April I have been contacting Discovery for an updated status (since this seems the only way to be in the loop) - it has been in underwriting since the 29 April as informed by a new business consultant. I phoned Discovery today to be informed that an acceptance letter had been generated with a 3 month general waiting period- I was flabberghasted. The general waiting period means no doctors visits will be covered, no medication etc for 3 months. Since when is this even related to my chronic condition. I am not trying to gain anything I would not have had at another medical aid. If I get ill with flu etc how does that emanate from my chronic condition. I was told it could only be escalated to a specialist who would not review my situation but would phone me to tell me why the waiting period had been app****. Absolute NONSENSE!! I was told that due to my category 3 "illness" - major depression that was the norm. Has my acceptance even been granted according to the medical aid regulations?!

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Replies (1)
Discovery Health
Discovery Health's reply10 May 2016, 06:59
Official

Thank you for allowing me to address your concerns.

The Medical Schemes Act (the Act) forbids medical schemes from declining membership to anyone. However, it allows medical schemes to protect their risk pools by using the waiting periods and late joiner penalties. All underwriting has to comply with legislation.

Based on the information on your application form, a three-month general waiting period was app****, but you do have access to the Prescribed Minimum Benefits (PMBs) according to the specific PMB criteria. I can confirm this was reviewed and is app**** correctly.

We understand that this may not be the outcome you had hoped for, however, it is in line with the Scheme rules.

Regards

Jashvir