1 reviews | Active since Oct 2016
Unreasonable Counter offer
I would like to start off by saying that I am terribly disappointed with Genesis Medical Scheme, and this after I have been a loyal customer of them for almost 5 years.
My father passed away on 13 May 2018, and my mother was on his medical aid which is Discovery which is the prescribed medical aid for that specific employer my dad worked for. I received my fathers final payslip and medical aid membership from his employer on 30 May 2018. There I've noticed that the medical aid will be termination on 31 May 2018. On 31 May 2018 we have decided that since we need to get medical aid for my mom asap, that Genesis would be our first choice, since I never had any trouble with them and the fact that their premiums are reasonable since my mom is unemployed which means that I would have to pay this monthly on her behalf. After sending all documentation to Genesis on 31st, I received a mail from Genesis which was the counter offer.
This was shocking... to say the least. The original plan we app**** for was the hospital plan with a premium of R1580.00. Then on 1 June we received the counter offer from Genesis.
1. A three month general waiting period during which time no benefit in respect of claims by you and your beneficiaries will be paid by Genesis. You are nevertheless liable to pay contributions during this period. 2. In accordance with the Medical Schemes Act 131 of 1998, a late joiner penalty has been imposed... 3. As a result of these additional conditions, your total contribution will be R2370.00 per month.
This honestly is ridiculous, since one of the required document Genesis required was the member certificate from Discover which states that both my mother and father had cover from 1 April 2015 to 31 May 2018.
My question now is..... Is Genesis not making their targets, and this be the reason for the additional monies??? And who does Genesis play this card also with...
This is not fare and Genesis should be ashamed of doing this... We did not ask for free Medical cover.
So, for those I ever referred to Genesis.... My apologies.... For once in my life, I was wrong.
What would have made sense, and we would have agreed to, is if they proposed a counter offer of paying the normal premium but cover will only start within the next month.
Dear Mr Brits
Whilst we can understand that you and your mom are not happy about the underwriting on her membership application, we need to categorically state that there is nothing “shocking or ridiculous” about the underwriting app**** and that the late joiner penalty (LJP) and waiting period that were imposed on your mom’s application, have absolutely nothing to do with making targets or playing “certain cards”, as you have imp****.
Underwriting is done strictly in accordance with the Medical Schemes Act - medical schemes may not impose LJPs or waiting periods “as they see fit”.
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.
According to the information that we received, you mom was without medical scheme cover for between 15 – 24 years, thereby qualifying for a 50% LJP. The below article explains very clearly how medical schemes have to apply LJPs:
https://www.genesismedical.co.za/industry-news/medical-aid-schemes-late-joiner-penalties/
As far as waiting periods are concerned, medical aid schemes in South Africa may impose certain waiting periods on new members when joining a medical scheme. Generally speaking, waiting periods depend on the amount of time an applicant has been a member of a South African medical scheme at the time of joining a new scheme. In addition, the new scheme will tend to assess the health risk profile of the applicant.
According to the Medical Schemes Act, medical aid schemes are entitled to impose a 3 months general waiting period [and/or a 12 months condition specific waiting period(s)] for any pre-existing medical condition(s). The Act makes specific provision for the imposition of waiting periods (and late joiner penalties as previously discussed) to protect the current membership pool of medical schemes from selective abuse. Waiting periods are not automatically app****, but depend on the health risk profile that is presented to the medical scheme at the time of application.
The article below discussed the topic of waiting periods in more detail.
https://www.genesismedical.co.za/industry-news/waiting-periods-medical-aid-schemes/
It may be that your mom was not underwritten on her membership when she app**** for cover at her previous medical scheme in 2014, as one often finds that group schemes (in other words, where all the employees of a company join a particular medical scheme) enjoy what is called an “underwriting concession”. When a medical scheme gives an underwriting concession to a certain employer group, it is based on the overall risk profile of the group and you may find that limited / no underwriting applies. However, when an individual joins a medical scheme, underwriting concessions are not applicable; hence, underwriting is done based on the risk profile of the individual applicant. This underwriting is also not just applicable to Genesis Medical Scheme - that is how all medical schemes underwrite.
You may want to make an enquiry with your new employer as to whether they will accept your mom on your new medical aid - they may waiver her underwriting if it is part of a group scheme, but having said that, underwriting concessions may not be applicable to parents. It may be worth your while to make an enquiry in this regard though.
Yours sincerely
THE GENESIS TEAM
Dear Mr Brits
Whilst we can understand that you and your mom are not happy about the underwriting on her membership application, we need to categorically state that there is nothing “shocking or ridiculous” about the underwriting app**** and that the late joiner penalty (LJP) and waiting period that were imposed on your mom’s application, have absolutely nothing to do with making targets or playing “certain cards”, as you have imp****.
Underwriting is done strictly in accordance with the Medical Schemes Act - medical schemes may not impose LJPs or waiting periods “as they see fit”.
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.
According to the information that we received, you mom was without medical scheme cover for between 15 – 24 years, thereby qualifying for a 50% LJP. The below article explains very clearly how medical schemes have to apply LJPs:
https://www.genesismedical.co.za/industry-news/medical-aid-schemes-late-joiner-penalties/
As far as waiting periods are concerned, medical aid schemes in South Africa may impose certain waiting periods on new members when joining a medical scheme. Generally speaking, waiting periods depend on the amount of time an applicant has been a member of a South African medical scheme at the time of joining a new scheme. In addition, the new scheme will tend to assess the health risk profile of the applicant.
According to the Medical Schemes Act, medical aid schemes are entitled to impose a 3 months general waiting period [and/or a 12 months condition specific waiting period(s)] for any pre-existing medical condition(s). The Act makes specific provision for the imposition of waiting periods (and late joiner penalties as previously discussed) to protect the current membership pool of medical schemes from selective abuse. Waiting periods are not automatically app****, but depend on the health risk profile that is presented to the medical scheme at the time of application.
The article below discussed the topic of waiting periods in more detail.
https://www.genesismedical.co.za/industry-news/waiting-periods-medical-aid-schemes/
It may be that your mom was not underwritten on her membership when she app**** for cover at her previous medical scheme in 2014, as one often finds that group schemes (in other words, where all the employees of a company join a particular medical scheme) enjoy what is called an “underwriting concession”. When a medical scheme gives an underwriting concession to a certain employer group, it is based on the overall risk profile of the group and you may find that limited / no underwriting applies. However, when an individual joins a medical scheme, underwriting concessions are not applicable; hence, underwriting is done based on the risk profile of the individual applicant. This underwriting is also not just applicable to Genesis Medical Scheme - that is how all medical schemes underwrite.
You may want to make an enquiry with your new employer as to whether they will accept your mom on your new medical aid - they may waiver her underwriting if it is part of a group scheme, but having said that, underwriting concessions may not be applicable to parents. It may be worth your while to make an enquiry in this regard though.
Yours sincerely
THE GENESIS TEAM