1 reviews | Active since Nov 2020
Unfair Termination and Declined Procedure Without Proper Investigation
I joined Medihelp in September 2025 and was shocked when my hospital authorisation for a minor keloid removal was declined and my membership was terminated soon after. They claimed I failed to disclose a “pre-existing condition” even though the small skin bump wasn’t serious, wasn’t diagnosed or treated before joining, and definitely not life-threatening.
I’ve requested their forensic report and proof that the omission was material under the Medical Schemes Act, but so far there’s been no clear justification. It’s disappointing that a medical scheme would cancel membership and deny care for something as harmless as a keloid scar, especially during a period when premiums were paid in full.
I am escalating this matter to the Council for Medical Schemes for proper review. Members deserve fairness, transparency, and due process — not rushed assumptions that leave patients liable for their own hospital bills.
Thank you for taking time to bring your complaint to our attention. The contents have been noted and we are currently investigating the matter.
The complaint will be responded to by one of our consultants.
Kind regards
Medihelp Customer Care
Thank you for taking time to bring your complaint to our attention. The contents have been noted and we are currently investigating the matter.
The complaint will be responded to by one of our consultants.
Kind regards
Medihelp Customer Care
It’s important for members to know that under Section 29(2)(e) of the Medical Schemes Act 131 of 1998, a medical scheme can only terminate membership if a member knowingly and materially failed to disclose information that would have influenced the scheme’s decision to accept them or set their contribution. This means both intentional nondisclosure and material impact must be proven — not just assumed.
In my case, the issue involved a minor, non-serious skin concern that was not diagnosed or treated before joining. It was not life-threatening, chronic, or medically significant. According to past rulings by the Council for Medical Schemes (CMS) and South African courts (Steyn v Registrar of Medical Schemes, 2021; Swanepoel N.O. v Profmed, 2023), such a condition cannot be considered “material” nondisclosure.
I have therefore referred the matter to the Council for Medical Schemes for independent review. Members deserve fair treatment, due process, and the protection guaranteed by law — not termination based on assumptions or technicalities.
It’s important for members to know that under Section 29(2)(e) of the Medical Schemes Act 131 of 1998, a medical scheme can only terminate membership if a member knowingly and materially failed to disclose information that would have influenced the scheme’s decision to accept them or set their contribution. This means both intentional nondisclosure and material impact must be proven — not just assumed.
In my case, the issue involved a minor, non-serious skin concern that was not diagnosed or treated before joining. It was not life-threatening, chronic, or medically significant. According to past rulings by the Council for Medical Schemes (CMS) and South African courts (Steyn v Registrar of Medical Schemes, 2021; Swanepoel N.O. v Profmed, 2023), such a condition cannot be considered “material” nondisclosure.
I have therefore referred the matter to the Council for Medical Schemes for independent review. Members deserve fair treatment, due process, and the protection guaranteed by law — not termination based on assumptions or technicalities.