BG
Bernie G
1 reviews | Active since Dec 2019
03 Dec 2019, 16:19
Dissatisfaction with Genesis Medical Scheme
When applying to have dental treatment there were all sorts of documentation required from past treatment received from doctors etc. The toothache was unbearable and after three weeks of having to submit medical records etc the end result was that the cover under the scheme was terminated by Genesis Medical Scheme. The reason that was given is that certain disclosures were not given when the initial application form was completed. History that was omitted was doctors visits from six years ago. This information was not willfully omitted... it was just forgotten about. So, if you should be considering joining Genesis Medical Scheme and you fill in the application form please remember to include ALL doctors (or other) visits from birth as if you should be in the unfortunate position to want to claim for medical attention you will after three weeks find out that you omitted "something" on your application and Genesis will terminate your membership. The one star rating was only given so that this review could be written.
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Genesis Medical Scheme's replyOfficial
04 Dec 2019, 12:24Dear Bernie
Thank you for taking our call this morning and also for clarifying that your review was not for yourself, but on behalf of a relative.
The issue of medical scheme non-disclosure is viewed so seriously by the Legislature that it provides for termination of membership. The issue around the non-declaration of information is often a bitter pill to swallow for the member concerned.
New applicants are always required to disclose their current and previous medical history in terms of conditions and / or treatment received. From this information the medical scheme will then assess their risk profile and may impose certain general and / or condition specific waiting periods . This is done to protect current members of the scheme from new members who may purely join a scheme to claim for a certain event – for example, if they need an operation, and then leave the scheme again before they have made any meaningful contributions to the risk pool of the scheme (an act referred to as anti-selection). Anti-selection prejudices other members who are contributing to the scheme on an ongoing basis and then have to carry the cost of those members who anti-select.
In this specific instance, the member had joined Genesis as recently as October 2019.
It soon became clear that the member failed to disclose truthfully details about her and her spouse’s past medical history - not only from six years ago, but from as recent as 2018 and 2019. The application form completed by the member required a full and honest disclose of ALL conditions that affected their health and for which treatment was prescribed or recommended, prior to completing the application form and having their membership become active. Further to this, the member declared that all her answers and the information supp**** in the application, were true, correct and complete in every respect.
Material information was however omitted from the application form. The law is very clear when it comes to disclosure; it is not for the applicant to decide what is relevant and what is not. It is for the insurer (Genesis Medical Scheme) to make that decision.
The trustees of medical schemes have a responsibility to the membership of the scheme as a whole, particularly those members who fully declared details of pre-existing conditions when joining the scheme and who were subject to the schemes’ normal underwriting criteria. Medical cover is not a sale transaction where the purchaser is entitled to receive the goods or services for which he / she has paid. Instead, it is an insurance transaction where there are conditions attached to a scheme’s responsibilities under the insurance contract. If a member breaches those conditions, then the scheme’s obligation is not triggered.
Honesty and full disclosure are imperative when joining a medical scheme. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for members, their families and their doctors.
Much has been written about this subject in the media, especially over the last two years. The following articles, published on our website, elaborate on the subject.
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-1/
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-2/
https://www.genesismedical.co.za/non-disclosure-no-innocent-*****/
We trust that the above explanation will assist you in understanding the challenges and complexities around the topic of non-declaration of information and the (possible) termination of membership.
Yours sincerely
GENESIS MEDICAL SCHEME
Thank you for taking our call this morning and also for clarifying that your review was not for yourself, but on behalf of a relative.
The issue of medical scheme non-disclosure is viewed so seriously by the Legislature that it provides for termination of membership. The issue around the non-declaration of information is often a bitter pill to swallow for the member concerned.
New applicants are always required to disclose their current and previous medical history in terms of conditions and / or treatment received. From this information the medical scheme will then assess their risk profile and may impose certain general and / or condition specific waiting periods . This is done to protect current members of the scheme from new members who may purely join a scheme to claim for a certain event – for example, if they need an operation, and then leave the scheme again before they have made any meaningful contributions to the risk pool of the scheme (an act referred to as anti-selection). Anti-selection prejudices other members who are contributing to the scheme on an ongoing basis and then have to carry the cost of those members who anti-select.
In this specific instance, the member had joined Genesis as recently as October 2019.
It soon became clear that the member failed to disclose truthfully details about her and her spouse’s past medical history - not only from six years ago, but from as recent as 2018 and 2019. The application form completed by the member required a full and honest disclose of ALL conditions that affected their health and for which treatment was prescribed or recommended, prior to completing the application form and having their membership become active. Further to this, the member declared that all her answers and the information supp**** in the application, were true, correct and complete in every respect.
Material information was however omitted from the application form. The law is very clear when it comes to disclosure; it is not for the applicant to decide what is relevant and what is not. It is for the insurer (Genesis Medical Scheme) to make that decision.
The trustees of medical schemes have a responsibility to the membership of the scheme as a whole, particularly those members who fully declared details of pre-existing conditions when joining the scheme and who were subject to the schemes’ normal underwriting criteria. Medical cover is not a sale transaction where the purchaser is entitled to receive the goods or services for which he / she has paid. Instead, it is an insurance transaction where there are conditions attached to a scheme’s responsibilities under the insurance contract. If a member breaches those conditions, then the scheme’s obligation is not triggered.
Honesty and full disclosure are imperative when joining a medical scheme. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for members, their families and their doctors.
Much has been written about this subject in the media, especially over the last two years. The following articles, published on our website, elaborate on the subject.
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-1/
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-2/
https://www.genesismedical.co.za/non-disclosure-no-innocent-*****/
We trust that the above explanation will assist you in understanding the challenges and complexities around the topic of non-declaration of information and the (possible) termination of membership.
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply04 Dec 2019, 12:24
Official
Dear Bernie
Thank you for taking our call this morning and also for clarifying that your review was not for yourself, but on behalf of a relative.
The issue of medical scheme non-disclosure is viewed so seriously by the Legislature that it provides for termination of membership. The issue around the non-declaration of information is often a bitter pill to swallow for the member concerned.
New applicants are always required to disclose their current and previous medical history in terms of conditions and / or treatment received. From this information the medical scheme will then assess their risk profile and may impose certain general and / or condition specific waiting periods . This is done to protect current members of the scheme from new members who may purely join a scheme to claim for a certain event – for example, if they need an operation, and then leave the scheme again before they have made any meaningful contributions to the risk pool of the scheme (an act referred to as anti-selection). Anti-selection prejudices other members who are contributing to the scheme on an ongoing basis and then have to carry the cost of those members who anti-select.
In this specific instance, the member had joined Genesis as recently as October 2019.
It soon became clear that the member failed to disclose truthfully details about her and her spouse’s past medical history - not only from six years ago, but from as recent as 2018 and 2019. The application form completed by the member required a full and honest disclose of ALL conditions that affected their health and for which treatment was prescribed or recommended, prior to completing the application form and having their membership become active. Further to this, the member declared that all her answers and the information supp**** in the application, were true, correct and complete in every respect.
Material information was however omitted from the application form. The law is very clear when it comes to disclosure; it is not for the applicant to decide what is relevant and what is not. It is for the insurer (Genesis Medical Scheme) to make that decision.
The trustees of medical schemes have a responsibility to the membership of the scheme as a whole, particularly those members who fully declared details of pre-existing conditions when joining the scheme and who were subject to the schemes’ normal underwriting criteria. Medical cover is not a sale transaction where the purchaser is entitled to receive the goods or services for which he / she has paid. Instead, it is an insurance transaction where there are conditions attached to a scheme’s responsibilities under the insurance contract. If a member breaches those conditions, then the scheme’s obligation is not triggered.
Honesty and full disclosure are imperative when joining a medical scheme. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for members, their families and their doctors.
Much has been written about this subject in the media, especially over the last two years. The following articles, published on our website, elaborate on the subject.
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-1/
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-2/
https://www.genesismedical.co.za/non-disclosure-no-innocent-*****/
We trust that the above explanation will assist you in understanding the challenges and complexities around the topic of non-declaration of information and the (possible) termination of membership.
Yours sincerely
GENESIS MEDICAL SCHEME
Thank you for taking our call this morning and also for clarifying that your review was not for yourself, but on behalf of a relative.
The issue of medical scheme non-disclosure is viewed so seriously by the Legislature that it provides for termination of membership. The issue around the non-declaration of information is often a bitter pill to swallow for the member concerned.
New applicants are always required to disclose their current and previous medical history in terms of conditions and / or treatment received. From this information the medical scheme will then assess their risk profile and may impose certain general and / or condition specific waiting periods . This is done to protect current members of the scheme from new members who may purely join a scheme to claim for a certain event – for example, if they need an operation, and then leave the scheme again before they have made any meaningful contributions to the risk pool of the scheme (an act referred to as anti-selection). Anti-selection prejudices other members who are contributing to the scheme on an ongoing basis and then have to carry the cost of those members who anti-select.
In this specific instance, the member had joined Genesis as recently as October 2019.
It soon became clear that the member failed to disclose truthfully details about her and her spouse’s past medical history - not only from six years ago, but from as recent as 2018 and 2019. The application form completed by the member required a full and honest disclose of ALL conditions that affected their health and for which treatment was prescribed or recommended, prior to completing the application form and having their membership become active. Further to this, the member declared that all her answers and the information supp**** in the application, were true, correct and complete in every respect.
Material information was however omitted from the application form. The law is very clear when it comes to disclosure; it is not for the applicant to decide what is relevant and what is not. It is for the insurer (Genesis Medical Scheme) to make that decision.
The trustees of medical schemes have a responsibility to the membership of the scheme as a whole, particularly those members who fully declared details of pre-existing conditions when joining the scheme and who were subject to the schemes’ normal underwriting criteria. Medical cover is not a sale transaction where the purchaser is entitled to receive the goods or services for which he / she has paid. Instead, it is an insurance transaction where there are conditions attached to a scheme’s responsibilities under the insurance contract. If a member breaches those conditions, then the scheme’s obligation is not triggered.
Honesty and full disclosure are imperative when joining a medical scheme. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for members, their families and their doctors.
Much has been written about this subject in the media, especially over the last two years. The following articles, published on our website, elaborate on the subject.
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-1/
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-2/
https://www.genesismedical.co.za/non-disclosure-no-innocent-*****/
We trust that the above explanation will assist you in understanding the challenges and complexities around the topic of non-declaration of information and the (possible) termination of membership.
Yours sincerely
GENESIS MEDICAL SCHEME