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Jun 19, 2023

An ongoing trend in the medical schemes industry is the non-disclosure of material information. It is imperative that applicants to a scheme provide as much detail as possible regarding medical advice, diagnosis, care, or recommendation for treatment within a 12-month period, ending on the date on which they are applying for membership.

Depending on how the membership has been underwritten and the application of a 12-month monitoring period, Bestmed Medical Scheme may investigate all benefit authorisation requests received within the first 12 months of membership. This is to exclude the possibility of non-disclosure of material information in respect of the medical history and/or health status of any beneficiaries noted on the application form for membership.

In the case of a non-disclosure finding, Bestmed has the right either to:

  1. terminate the membership / beneficiary from inception, for which all premiums received will be refunded, less the claims paid by the Scheme.
  2. add a 12-month condition-specific waiting period from inception to the membership to exclude any claims from being processed for the condition(s) not disclosed.

The Medical Schemes Act makes provision for a membership to be terminated, where non-disclosure of material information is proven, and the law does not recognise ignorance as an excuse. It remains the responsibility of the applicant to make full disclosure of the required information pertaining to their application and/or all their dependants. Should your client wish to add a medical report from their family practitioner (FP), they are welcome to do so to ensure that all conditions are covered.

We urge all our advisors to ensure that when their clients are applying for membership at Bestmed Medical Scheme and completing the medical questionnaire on the application form in full, they provide as much detail as possible.

Please contact your dedicated Business Consultant for more information

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