SI
Shahirah I
1 reviews | Active since Jun 2021
04 Jun 2021, 15:08
Dissatisfied now WITH Genesis
Totally disappointed in this scheme, wen I app**** in 2019 I was granted medical aid by them and in previous medical aid I was treated by a doctor where my child underwent iron transfusions, so I knew she had iron defiency, being not well educated I was unaware until now that iron is part of blood disorder, so now I'm being terminated and have to pay the Scheme back close to R450000 for treatment paid by the scheme what the scheme authorized for, why should I be liable for this. Further more I am not getting back my contribution, I need that so I can take my child for cash treatment as R3200 is Alot of money for me. It's more than my rent. I honestly feel this scheme has no sympathy nor emphary as wen I signed up the person that I spoke to over the phone never even explain properly when I was answering the questions.. They very quick to put the buck on my side as Non Disclosure. All I want is my R3200 back asap
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Genesis Medical Scheme's replyOfficial
07 Jun 2021, 09:42 Good morning Shahirah
Your disappointment and feedback are noted and we do have a lot of empathy towards the situation that you find yourself in at the moment. Medical schemes have written so much on this topic, yet, non-disclosure of material information remains one of the biggest challenges that schemes deal with on a daily basis. 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 then assesses 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.
Whilst we acknowledge the fact that certain people may not be well versed in medical terminology, the specific conditions not disclosed in your membership application relate to fairly simple terminology, i.e. “blood disorder” and “digestive system disorder”. We accommodate applicants even further on our application form by asking them the question, “Should you or any of your nominated dependants have had any …. conditions or symptoms which are not directly covered in these questions, you are nonetheless obligated to disclose it. Are you aware of any such conditions?” Your answer to this question was also “NO”; yet, your daughter was hospitalised just one month prior to signing your application for membership. When a medical scheme terminates a membership on the grounds of a non-disclosure, the scheme is in fact acting in the best interest of all the other members of that scheme. Without this rigorous approach to this type of *****, the available pool of funds needed for the healthcare treatment for all members, will be depleted, driving up members’ contributions. Not only is this grossly unfair to the other members, particularly those members who fully declared details of pre-existing conditions when joining the Scheme and who were subject to the Scheme’s normal underwriting criteria, but it leaves the providers, who treat their patients with the best intention, diligence and care, exposed when they are not paid. The issue of medical scheme non-disclosure is viewed so seriously by the Legislature that it provides for termination of membership and it declared such behavior, when coupled with the submission of claims against a medical scheme, as a ******** offense. Honesty is just always the best policy. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for patients, their families and their doctors.
Yours sincerely
GENESIS MEDICAL SCHEME
Your disappointment and feedback are noted and we do have a lot of empathy towards the situation that you find yourself in at the moment. Medical schemes have written so much on this topic, yet, non-disclosure of material information remains one of the biggest challenges that schemes deal with on a daily basis. 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 then assesses 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.
Whilst we acknowledge the fact that certain people may not be well versed in medical terminology, the specific conditions not disclosed in your membership application relate to fairly simple terminology, i.e. “blood disorder” and “digestive system disorder”. We accommodate applicants even further on our application form by asking them the question, “Should you or any of your nominated dependants have had any …. conditions or symptoms which are not directly covered in these questions, you are nonetheless obligated to disclose it. Are you aware of any such conditions?” Your answer to this question was also “NO”; yet, your daughter was hospitalised just one month prior to signing your application for membership. When a medical scheme terminates a membership on the grounds of a non-disclosure, the scheme is in fact acting in the best interest of all the other members of that scheme. Without this rigorous approach to this type of *****, the available pool of funds needed for the healthcare treatment for all members, will be depleted, driving up members’ contributions. Not only is this grossly unfair to the other members, particularly those members who fully declared details of pre-existing conditions when joining the Scheme and who were subject to the Scheme’s normal underwriting criteria, but it leaves the providers, who treat their patients with the best intention, diligence and care, exposed when they are not paid. The issue of medical scheme non-disclosure is viewed so seriously by the Legislature that it provides for termination of membership and it declared such behavior, when coupled with the submission of claims against a medical scheme, as a ******** offense. Honesty is just always the best policy. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for patients, their families and their doctors.
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply07 Jun 2021, 09:42
Official
Good morning Shahirah
Your disappointment and feedback are noted and we do have a lot of empathy towards the situation that you find yourself in at the moment. Medical schemes have written so much on this topic, yet, non-disclosure of material information remains one of the biggest challenges that schemes deal with on a daily basis. 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 then assesses 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.
Whilst we acknowledge the fact that certain people may not be well versed in medical terminology, the specific conditions not disclosed in your membership application relate to fairly simple terminology, i.e. “blood disorder” and “digestive system disorder”. We accommodate applicants even further on our application form by asking them the question, “Should you or any of your nominated dependants have had any …. conditions or symptoms which are not directly covered in these questions, you are nonetheless obligated to disclose it. Are you aware of any such conditions?” Your answer to this question was also “NO”; yet, your daughter was hospitalised just one month prior to signing your application for membership. When a medical scheme terminates a membership on the grounds of a non-disclosure, the scheme is in fact acting in the best interest of all the other members of that scheme. Without this rigorous approach to this type of *****, the available pool of funds needed for the healthcare treatment for all members, will be depleted, driving up members’ contributions. Not only is this grossly unfair to the other members, particularly those members who fully declared details of pre-existing conditions when joining the Scheme and who were subject to the Scheme’s normal underwriting criteria, but it leaves the providers, who treat their patients with the best intention, diligence and care, exposed when they are not paid. The issue of medical scheme non-disclosure is viewed so seriously by the Legislature that it provides for termination of membership and it declared such behavior, when coupled with the submission of claims against a medical scheme, as a ******** offense. Honesty is just always the best policy. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for patients, their families and their doctors.
Yours sincerely
GENESIS MEDICAL SCHEME
Your disappointment and feedback are noted and we do have a lot of empathy towards the situation that you find yourself in at the moment. Medical schemes have written so much on this topic, yet, non-disclosure of material information remains one of the biggest challenges that schemes deal with on a daily basis. 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 then assesses 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.
Whilst we acknowledge the fact that certain people may not be well versed in medical terminology, the specific conditions not disclosed in your membership application relate to fairly simple terminology, i.e. “blood disorder” and “digestive system disorder”. We accommodate applicants even further on our application form by asking them the question, “Should you or any of your nominated dependants have had any …. conditions or symptoms which are not directly covered in these questions, you are nonetheless obligated to disclose it. Are you aware of any such conditions?” Your answer to this question was also “NO”; yet, your daughter was hospitalised just one month prior to signing your application for membership. When a medical scheme terminates a membership on the grounds of a non-disclosure, the scheme is in fact acting in the best interest of all the other members of that scheme. Without this rigorous approach to this type of *****, the available pool of funds needed for the healthcare treatment for all members, will be depleted, driving up members’ contributions. Not only is this grossly unfair to the other members, particularly those members who fully declared details of pre-existing conditions when joining the Scheme and who were subject to the Scheme’s normal underwriting criteria, but it leaves the providers, who treat their patients with the best intention, diligence and care, exposed when they are not paid. The issue of medical scheme non-disclosure is viewed so seriously by the Legislature that it provides for termination of membership and it declared such behavior, when coupled with the submission of claims against a medical scheme, as a ******** offense. Honesty is just always the best policy. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for patients, their families and their doctors.
Yours sincerely
GENESIS MEDICAL SCHEME