1 reviews | Active since Nov 2017
Unfairly treated by Genesis medical aid
I was accused of trying being faudulant and trying to have a operation and hiding infirmation on my application form. After sending them a letter from my general practioner they took me off the medical scheme. No word from them again and no letter from them again. They said they will refund me my premiums but did untill tiday nit received a letter or email if the amount?
Dear Mrs Lourens
It is unfortunate that you feel you have been treated unfairly by Genesis Medical Scheme.
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 the applicant’s 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 join a scheme purely 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.
Your membership application required you, amongst other things, to make full and proper disclosure relating to both past and present health conditions. The questions are clear, unambiguous and easy to understand.
According to information made available to us by your doctor and not refuted or disputed by you, you failed to disclose all of your medical history prior to joining Genesis. We never accused you of anything; in fact, you admitted to not having told us. The fact of the matter is therefore that material information, however unintentional or innocent it may have been, was omitted from the application form completed by you.
The Board of Trustees has a broader responsibility to our membership as a whole, particularly those applicants who fully declare details of pre-existing medical conditions when joining and are subject to the Scheme’s normal underwriting criteria and / or waiting periods.
However innocent, unintentional and with or without malice the non-disclosure may have been, the fact of the matter is that you have failed to disclose material information in your application.
Contributions paid by you, less the claims that have been paid out on your behalf and a deduction for administrative fees will be refunded to you by the end of the month.
GENESIS MEDICAL SCHEME
Dear Mrs Lourens
It is unfortunate that you feel you have been treated unfairly by Genesis Medical Scheme.
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 the applicant’s 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 join a scheme purely 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.
Your membership application required you, amongst other things, to make full and proper disclosure relating to both past and present health conditions. The questions are clear, unambiguous and easy to understand.
According to information made available to us by your doctor and not refuted or disputed by you, you failed to disclose all of your medical history prior to joining Genesis. We never accused you of anything; in fact, you admitted to not having told us. The fact of the matter is therefore that material information, however unintentional or innocent it may have been, was omitted from the application form completed by you.
The Board of Trustees has a broader responsibility to our membership as a whole, particularly those applicants who fully declare details of pre-existing medical conditions when joining and are subject to the Scheme’s normal underwriting criteria and / or waiting periods.
However innocent, unintentional and with or without malice the non-disclosure may have been, the fact of the matter is that you have failed to disclose material information in your application.
Contributions paid by you, less the claims that have been paid out on your behalf and a deduction for administrative fees will be refunded to you by the end of the month.
GENESIS MEDICAL SCHEME