******** WAITING PERIOD IMPOSED BY DISCOVERY HEALTH.

Some background information:

My wife is retiring at the end of this month (Jan 2025). We were on the Netcare Medical Scheme which is a closed membership scheme.

After her retirement I will be the main breadwinner and because of affordability I had to apply for a different and more affordable plan now being an open membership scheme.

I did so late last year. My wife ended our membership of the Netcare Medical Scheme on 31/12/2024 motivated by her retirement. Our new scheme's membership started on 1 January 2025. There was no break in cover.

To our shock we saw on the membership certificate of the new fund that a general waiting period of three months apply.

Section 29(3)(c) of the Medical Schemes Act states: "A medical scheme shall not provide in its rules— (c) for the imposition of waiting periods or new restrictions on account of the state of health of any member who has been a member or a dependent of a member of another medical scheme for a continuous period of at least two years and whose membership has been terminated because of change of employment and who applies for membership within three months after the termination of membership from the other medical scheme."

We have been members of Netcare Medical Scheme since April 2008.

I took this matter up with Discovery with no positive outcome so far.

I am experiencing that they draw out this matter as long as possible with the aim to draw out this dispute as long as possible - perhaps the whole three months of the waiting period.

My wife has been asked to get a letter from her employer confirming her retirement.

In terms of S29(3)(c) of the Act Discovery confirmed change of employment - from full time employee to pensioner, and our membership of their medical aid was much longer of the minimum of 2 years.

Its simple: There may not be waiting periods imposed by our new fund.

But they went further:

My wife has been asked for a letter from the employer to explain why she cannot continue her membership of the Netcare Medical Scheme after retirement despite the fact that she said it was for personal financial reasons when asked why she discontinued her Netcare Medical Scheme membership.

All Discovery had to do is establish change of employment. That was done. The financial reasons for our decision have nothing to do with anyone including Discovery. Why the hell does my wife have to go to her HR Department for a letter to state why she decided not to continue our membership of Netcare Medical Scheme? That is personal - very personal.

Today, a new excuse for the waiting period popped up: We moved from a closed membership scheme (as if we had a choice) to an open medical scheme. Where in the Act do I find this? I asked the agent - two of them. No-one could tell me. The last person I spoke to said it is the Scheme Rules that says so. Well, that is against le Law quoted above irrespective if the change is from an Open Scheme to a Closed Scheme.

Discovery, are we in for a three month's fight? It is simple with no gray area in the Law with regards to this. There is an established change in employment. There is continuous membership since 2008. The Law disallows the imposition of waiting periods. IT IS LAW!!!! We are all equal under the law. Discovery may not be above the Law.