Rare Diseases South Africa (RDSA) has been inundated with calls over the weekend from panicked members of Health Squared Medical Scheme (Health Squared) following their notice of voluntary liquidation.
This situation is an unusual scenario in the Medical Schemes environment, with Health Squared not being able to reach an appropriate merge with any other scheme. This has left all of the Health Squared members in the precarious position of having just 8 business days to seek new medical scheme coverage.
The patients who have contacted us are all chronic patients requiring ongoing care. RDSA has reached out the Registrar of the Council for Medical Schemes to determine if members seeking new membership will be treated the same as in the case of a merge / acquisition, ultimately removing imposed waiting periods and exclusions. We have not yet received a response but will keep our members appraised of any response received.
In our attempt to alleviate some of the concerns, we have included some important information below.
1) Does this mean that my current claims won’t be covered?
As per the notice sent out to Health Squared members, claims will be covered for incidents up to and including 31 August 2022.
2) Can I be excluded from joining a new medical scheme?
The Medical Schemes Act states that medical schemes must accept anyone who can afford their premiums. You cannot be excluded from joining a scheme due to pre-existing conditions, race, age, sex, gender, ethnic or social origin, sexual orientation, or disability. However, Schemes are able to impose waiting periods.
3) What are the waiting period timeframes?
On admission to membership a scheme may impose a:
• 3 month general waiting period
• 12 months condition-specific waiting periods (CSWP) for pre-existing conditions
• Waiting period on PMBs
• Late Joiner Penalty
Below is a table of the waiting periods (W/P) that can be applied
CATEGORY | 3 Month General W/P | ​12 Month Condition Specific W/P | Application to PMB |
​New applicants, or persons not members of another scheme for preceding 90 days | Yes | Yes | Yes |
​Applicants who were members for less than 2 years | No | Yes | No |
Applicants who were members for more than 2 years | Yes | No | No |
Change of benefit option | No | No | No |
Child-dependant born during period of membership | No | No | N/A |
​Involuntary transfers due to change of employment or employer changing scheme | No | No | N/A |
4) Can I be a member of more than one scheme at the same time?
Neither members, nor their dependants, may belong to more than one scheme at any time. Members may not transfer benefits to persons not registered on their medical scheme.
5) What should I do now?
1. RDSA suggests urgently getting in touch with a brokerage service, to enquire about a new medical scheme. Ensure that you complete a health assessment and that you divulge your current health needs. Be honest and open with the new schemes. If you are found to have provided false information, you may lose your membership or have it suspended. If you act illegally, criminal charges may be laid against you.
2. Get a completed claims statement from your Health Squared for the last 12 months to ensure that you have records of the treatments you required. Request copies of the current approvals that are in place for your current treatments and chronic conditions from Health Squared – this will make applications for the same benefits at the new scheme easier.
3. Get in touch with your treating clinicians and request updated scripts, latest medical reports etc., as you will need these when applying for chronic benefits at your new scheme.
4. Ensure you request the relevant forms from your Broker ahead of time for chronic benefits so that you can have those completed as soon as possible to prevent a disruption in your treatment.
RDSA is committed to ensuring our patient members are well supported through this difficult time. If you are having any difficulty in getting in touch with a broker or getting the necessary forms etc. required at the new scheme you have selected, please send us an email to assist@rarediseases.co.za for us to assist you.