Genisis pathetic

Dear Mr Venter We had a look into your enquiry and without going into any clinical and confidential detail about your daughter, we can confirm that this matter is unfortunately related to her membership being terminated ab initio (as if it never happened).  The termination of her membership was as a result of NON-DISCLOSURE OF MATERIAL INFORMATION.  To this end, we refer you to correspondence sent to your daughter on 21 May 2020 and again on 25 May 2020. In terms of information available to us and not refuted or disputed by your daughter, she failed to disclose her earlier consultations with her doctor;  in particular, her consultations with him in 2018 and 2019, and again on 24 February and  26 February 2020.  During these consultations, she was diagnosed with certain conditions, underwent certain tests / examinations and treatment was prescribed.   The consultations with her doctor twice in February 2020 occurred merely 3 and 5 days prior to her completing her application for membership.  In addition, during the visit to her doctor on 26 February 2020, he referred her to a Cardiologist.  None of this information was disclosed to the Scheme. During a routine medical history review that followed, it became manifestly clear that she failed to disclose truthfully details of her past medical history. The application form completed by her required a full and honest disclosure of all conditions that affected her health and for which treatment was prescribed or recommended, prior to completing the application form and having her membership become active. The Genesis application form clearly states the following: “Have you, your spouse or any other of your dependants experienced any of the following conditions or sought or obtained any medical advice, treatment or counselling in respect thereof?” Despite having afforded her an opportunity to dispute the information available to us, the fact nevertheless remains that material information was omitted from the application form completed by her. The questions on the application form are clear and easy to understand. The law is also 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 to make that decision, in this case Genesis. We would also like to refer  you to an extract from the membership application form which she signed on 29 February 2020, in which she declared: “I declare that my answers and the information supp**** by me in this application, whether in my own handwriting or not, are true, correct and complete in every respect.” The Board of Trustees has a broader responsibility to the membership as a whole, particularly those applicants who fully declared details of previous medical conditions, when joining and were subject to the Scheme’s normal underwriting criteria.  These omissions on her side, however unintentional, innocent and without malice, were not the fault of the Scheme and so understandably, the Board (and the Rules) required that some action be taken in order to be fair to the membership as a whole. Accordingly and having considered all the information at its disposal, the Scheme informed your daughter that her membership was terminated ab initio (as if it never happened).  In other words, although her join date with the Scheme was 1 March 2020, the ab initio termination effectively means that she was never a member of the Scheme. 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.

 Not only is the act of non-disclosure of material information grossly unfair to the other members, but it leaves the providers, i.e. Vergelegen Mediclinic and her treating doctors, who treated her with the best intention, diligence and care, exposed when they are not paid.   
Medical schemes cannot refuse an applicant’s application, or increase their monthly contributions for any previous or existing health condition that they may suffer from (or may have suffered from).  The “worst” that may happen, is that they may receive certain waiting periods on certain conditions.  
Honesty is always the best policy.

We trust that this feedback will help you to understand the situation.  Please also share this with your lawyer. 
Yours sincerely
GENESIS MEDICAL SCHEME