1 reviews | Active since Aug 2010
Reversal of paid claims
I was a member of the Engen Medical Aid Fund up until the end of December 2015 and have the membership certificate indicating such. I submitted and had claims paid up until this date.<br> <br> In January/February of this year I was contacted by previously paid service providers indicating that they had their payments reversed. Upon contacting the medical aid I was told the reason was that my dependent had resigned from the fund, which is clearly incorrect as per my membership certificate. They also stated the date of resignation being the same date as his birth. Strange that someone would join and retire on the same date?<br> <br> I then received a manufactured membership certificate with today's date, the 14th March 2016, stating that he according to them, had joined and left on the same date hence the reason for the reversal. So they created a **** membership certificate to avoid paying claims and justify the reversals.<br>
According to the rules of the Fund, dependants born into the Fund will enjoy immediate cover, hence the dependant's join date was the same as his birth/benefit date. No contributions was paid for the new dependant and as a result, the dependant was resigned effective 28 August 2015. In order for the claims to be considered for payment, the member needs to pay the outstanding contribution.
Following our telephone conversation, it was confirmed that the outstanding contributions would be paid by yourself.
We apologise for any inconvenience caused.
Kind regards
The Metropolitan Health team
According to the rules of the Fund, dependants born into the Fund will enjoy immediate cover, hence the dependant's join date was the same as his birth/benefit date. No contributions was paid for the new dependant and as a result, the dependant was resigned effective 28 August 2015. In order for the claims to be considered for payment, the member needs to pay the outstanding contribution.
Following our telephone conversation, it was confirmed that the outstanding contributions would be paid by yourself.
We apologise for any inconvenience caused.
Kind regards
The Metropolitan Health team
