MALICIOUS PERSUIT BY KEY HEALTH'S NDC DEPARTMENT

On 1 November 2023 I became a member of Key-Health, after I had to change from medical scheme due to change of employment. I've been a member of my previous medical scheme for more than 24 months (more than 4 years to be exact). Upon completing the application form, I had to complete my previous medical details and underneath Section 6, Section 6.1 read as follows "If no medical aid is indicated above then further medical details must be provided".

A pre-authorisation was then requested, after which I was informed by KeyHealth, that I will now be investigated for possible non disclosure of "material information". Of which the term "material information" is a very broad term and not defined in their policy or any act relating to medical aids.

I then received correspondence from their ndc department and had to submit various information, including my previous medical record (of which was freely available to Key Health, but never requested, until now). It was indicated to me that the findings was almost all "not disclosed". They basically took my medical history record and marked each and every claim in the past as "not disclosed". This includes over flu treatment, etc...

I had to provide a lot of additional information, of which I could not obtain all of it myself, and within a weeks time. I was also never given a dead line as to when I must provide the information. The next email I received was to inform me that they did not receive everything as requested and has now referred the matter to be decided on. I was never followed up with, not telephonically or by email.

The "investigation" was forwarded to the executive official prematurely, as I was not able to submit all requested information and there was no due date given to me. I was also not afforded the opportunity to state my case or to defend the findings.

The ndc department's referral was that allmost all previous medical conditions/claims were not disclosed. This is not correct, as I did disclose my previous medical scheme's information on the application as was requested in terms of Section 6 and Sub-Section 6.1 of the Application. I also submitted all documents requested thereafter. My previous medical history was at all times available, but was only requested now and currently being used against me as information that was not disclosed.

If this is indeed not the case then KeyHealth must certainly have a look at their current application form, as it currently is vague and confusing. The application form is clear, that if a medical aid is indicated in Section 6 of the application, then further medical details must not be provided. This is how any reasonable person will interpret Section 6 of the application form.

In terms of the Act and the Scheme Rules I was a dependent member of a medical aid for a period of more than 24 months and had to change medical schemes due to change of employment. This also means that there is an existing record of my medical history.

Given the above and in line with Sections 9.3, 9.5, 9.6 and 13.6 of the Scheme Rules, I comp**** with all the rules and the Act, in that no information was deliberately omitted on an application. All requested information was disclosed. There was therefore no waiting period and am I now being prejudiced by the Scheme's malicious pursuit.

What also is very concerning, is the fact that membership can be suspended, without the member having had an opportunity to state their case and also have the risk that most offices close during this time, which means if anything happens over the festive period there is a possibility that myself and my dependents will not be covered by a medical aid.

I am not in arrears with membership, I've been on a previous medical aid for more than 24 months and have disclosed all information requested.

I've been part of a medical scheme my whole life and never had any issues or being pursued as if a ******** and being treated as I am being treated now.

case numbers #wf_***; CASE***; wf_***