LH
Linda H
1 reviews | Active since Sept 2017
01 Jul 2021, 13:08
Genesis inappropriate usage of Late joiners penalties to exploit us
This arrogant greedy moneygrabbing company is trying to exploit this pensioner by applying a 50% late joiner fee.
This is blatant exploitation of our pensioners and population. This government must do away with these mefical aids.
My Mother has been paying medical aids for over 35 years without any breaks. There has never been any one medical aid that has assessed the need, according to the medical aid legislation, to apply any late joiner fee.
On her Discovery membership certificate it states clearly no late joiner fee is applicable. Now we app**** to Genesis and they see themselves as above everyone else. After weeks of goung to and fro on their applucation, I had to redo the form. You are forced to provide confidential information and give them access to your bank funds via a debit order approval BEFORE even getting a quotation. This information is not required for a quotation and there fore contravenes POPI legislatikn. We were asked fir the current mefical aid member certificat which we submitted. We finally got a quotation which applued a 50% late joiner penalty. Well, Genesis, you know wjat you can do with your services and penalty.
This blatant exploitation disgusts me.
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Genesis Medical Scheme's replyOfficial
01 Jul 2021, 14:35 Dear Linda
All the adjectives used in your complaint are truly inappropriate and totally unfounded.
The Late Joiner Penalty (LJP) that was app**** to your mom’s membership application has absolutely nothing to do with “money grabbing”, “exploitation” and all the other accusations you make.
According to the Medical Schemes Act, medical schemes may impose LJPs. It has absolutely nothing to do with being "arrogant", "greedy", etc.
We have explained this before: https://www.genesismedical.co.za/medical-aid-schemes-late-joiner-penalties/
We have explained this before: https://www.genesismedical.co.za/medical-aid-schemes-late-joiner-penalties/
The funding model for medical schemes is based on the principle of cross-subsidisation. Generally speaking, younger / healthier members contribute for a reasonable period whilst not claiming anything major. During this period, they subsidise the higher claims of generally older / more sickly members. Over a period of time, the younger members will get older and will in turn benefit from the younger / healthier members who contribute to the risk pool. Selective abuse of medical scheme funds where large claims may be made shortly after joining a scheme at an older age, would result in increased contributions for all members.
Late joiner penalties explained
LJPs may be app**** in order to protect medical schemes from what is referred to as "anti-selection" - a practice of joining a scheme at a later stage in life when you are more likely to need expensive cover.
A “late joiner” refers to an applicant, or an adult dependant of an applicant who, at the date of application for membership or admission as a dependant, is 35 years of age or older and who was not a member of one or more medical schemes as from a date preceding 1 April 2001, without a break in coverage exceeding 3 consecutive months since 1 April 2001.
A “late joiner” refers to an applicant, or an adult dependant of an applicant who, at the date of application for membership or admission as a dependant, is 35 years of age or older and who was not a member of one or more medical schemes as from a date preceding 1 April 2001, without a break in coverage exceeding 3 consecutive months since 1 April 2001.
Late joiner premium penalties shall not exceed the following bands
Penalty bands (number of years of no cover after age 35) : Maximum penalty
1 – 4 years : 0.05 x monthly contribution
5 – 14 years : 0.25 x monthly contribution
15 – 24 years: : 0.50 x monthly contribution
1 – 4 years : 0.05 x monthly contribution
5 – 14 years : 0.25 x monthly contribution
15 – 24 years: : 0.50 x monthly contribution
25+ years : 0.75 x monthly contribution
Let us further explain this at the hand of the following scenario:
Mrs X is 78 and applies for medical aid membership. She belonged to a medical scheme for 19 years for from the age of 59.
Formula to calculate Mrs X’s late joiner penalty:
78 – (35 + 19) = 24.
Mrs X’s number of years without medical aid cover after the age of 35 and her current age are 24 years. She therefor qualifies for a 50% late joiner penalty on her monthly contribution. If the monthly contribution of the option she wants to join is R1 000 per month, her premium will therefor be R1 000 plus an extra 50% = R1 500.
Mrs X’s number of years without medical aid cover after the age of 35 and her current age are 24 years. She therefor qualifies for a 50% late joiner penalty on her monthly contribution. If the monthly contribution of the option she wants to join is R1 000 per month, her premium will therefor be R1 000 plus an extra 50% = R1 500.
Another fact to be taken into consideration, is that membership of overseas medical schemes, or medical insurance products, will not count as membership years in South Africa.
Yours sincerely
GENESIS MEDICAL SCHEME
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply01 Jul 2021, 14:35
Official
Dear Linda
All the adjectives used in your complaint are truly inappropriate and totally unfounded.
The Late Joiner Penalty (LJP) that was app**** to your mom’s membership application has absolutely nothing to do with “money grabbing”, “exploitation” and all the other accusations you make.
According to the Medical Schemes Act, medical schemes may impose LJPs. It has absolutely nothing to do with being "arrogant", "greedy", etc.
We have explained this before: https://www.genesismedical.co.za/medical-aid-schemes-late-joiner-penalties/
We have explained this before: https://www.genesismedical.co.za/medical-aid-schemes-late-joiner-penalties/
The funding model for medical schemes is based on the principle of cross-subsidisation. Generally speaking, younger / healthier members contribute for a reasonable period whilst not claiming anything major. During this period, they subsidise the higher claims of generally older / more sickly members. Over a period of time, the younger members will get older and will in turn benefit from the younger / healthier members who contribute to the risk pool. Selective abuse of medical scheme funds where large claims may be made shortly after joining a scheme at an older age, would result in increased contributions for all members.
Late joiner penalties explained
LJPs may be app**** in order to protect medical schemes from what is referred to as "anti-selection" - a practice of joining a scheme at a later stage in life when you are more likely to need expensive cover.
A “late joiner” refers to an applicant, or an adult dependant of an applicant who, at the date of application for membership or admission as a dependant, is 35 years of age or older and who was not a member of one or more medical schemes as from a date preceding 1 April 2001, without a break in coverage exceeding 3 consecutive months since 1 April 2001.
A “late joiner” refers to an applicant, or an adult dependant of an applicant who, at the date of application for membership or admission as a dependant, is 35 years of age or older and who was not a member of one or more medical schemes as from a date preceding 1 April 2001, without a break in coverage exceeding 3 consecutive months since 1 April 2001.
Late joiner premium penalties shall not exceed the following bands
Penalty bands (number of years of no cover after age 35) : Maximum penalty
1 – 4 years : 0.05 x monthly contribution
5 – 14 years : 0.25 x monthly contribution
15 – 24 years: : 0.50 x monthly contribution
1 – 4 years : 0.05 x monthly contribution
5 – 14 years : 0.25 x monthly contribution
15 – 24 years: : 0.50 x monthly contribution
25+ years : 0.75 x monthly contribution
Let us further explain this at the hand of the following scenario:
Mrs X is 78 and applies for medical aid membership. She belonged to a medical scheme for 19 years for from the age of 59.
Formula to calculate Mrs X’s late joiner penalty:
78 – (35 + 19) = 24.
Mrs X’s number of years without medical aid cover after the age of 35 and her current age are 24 years. She therefor qualifies for a 50% late joiner penalty on her monthly contribution. If the monthly contribution of the option she wants to join is R1 000 per month, her premium will therefor be R1 000 plus an extra 50% = R1 500.
Mrs X’s number of years without medical aid cover after the age of 35 and her current age are 24 years. She therefor qualifies for a 50% late joiner penalty on her monthly contribution. If the monthly contribution of the option she wants to join is R1 000 per month, her premium will therefor be R1 000 plus an extra 50% = R1 500.
Another fact to be taken into consideration, is that membership of overseas medical schemes, or medical insurance products, will not count as membership years in South Africa.
Yours sincerely
GENESIS MEDICAL SCHEME
Yours sincerely
GENESIS MEDICAL SCHEME