Medical Aid!

Hosehead said:
You can't pre authorise the Future. Yet. (for emergencies)
But for everything else you have to get preauthorisation anyways right?
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If preauthorisation is possible, do it. If its an emergency visit, make sure the medical aid is notified for post authorisation ASAP.
 
Discovery offers you the choice on their website of a variety of dates that you can have a debit order authorised. It reads so smooth and syrupy and easy. Default date is 1st of the month. Now say I want to change that to the 10th of the month it's not as easy as I thought. Lets use May as an example. Say I want my debit order to go out on May 10 because my income arrangements changed well Discovery wants you to pay the full month's debit order on May 01, then a full months debit order on May 10, and then your debit order will then only take effect from 10 June. That really sucks having to pay one month extra in advance to change the date of a debit order by 10 days.
Did you also know there is a penalty if you wish to remove a spouse or dependant from your plan? That penalty is one month of whatever you are paying monthly.
 
The reason all medical aids make it a mission to have any debit date other than the 1st is due to the fact the the laws governing medical schemes state that they have to be paid for in advance, not arrears. Therefor the only way you can have your debit date on any day after the 1st is to pay that extra month, so that no matter when you get debited you're always paying for the month to come.
 
gdiza said:
Use this thread as a good example!

http://mybroadband.co.za/vb/showthread.php/528460-Ook-s-Hospital-Visit?p=10329656
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In fairness, I suspect there are other factors at play here. 1 year exclusion isn't normal.

vash87 said:
The reason all medical aids make it a mission to have any debit date other than the 1st is due to the fact the the laws governing medical schemes state that they have to be paid for in advance, not arrears.
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Source? My med aid gets deducted directly from salary...on the 25th. And is definitely not paid for in advance (covered from 1st Jan, paid them for the first time on 25th).
 
Last edited:
Here is a medical aid question:

Facts: (desensitized version)
Child X, my son, is on my medical aid scheme.
Child lives in another province with my ex.
Child requires medical attention.
Mother Y takes child to Medical centre.
Medical centre generates an invoice in which Y presumably signs.
The invoice is processed using my medical aid – Shortfall of R1000.00
Me -totally oblivious - always receives the demand SMS’s and phone-calls from Medical centre because of the non-payment of the shortfall.

My contention is the fact that these situations arise without any knowledge imparted to me, from Y. I receive call from the medicross, my response is ‘I have no idea what you talking about, I am not aware of any medical shortfall nor any visit to your medical centre…” The centre always responds with “but he is on your medical aid” and you must be responsible…. I respond with “I realise such, but it is called a MEDICAL-AID, not called a MEDICAL-TAKE-ALL RESPONSIBILITY-WITHOUT-ANY- KNOWLEDGE-SCHEME”. In my opinion, the medical-aid scheme is merely an insurance scheme, which assists with payment - whereas the entire ‘contract of service’ is between the medical centre and whoever signed the invoice.

Legal Question: (forget the moral Q’s – I know where I stand on this)

Is it legal to generate a statement/invoice in my name?
If so, is it a legal-binding on me if Y signs it without my knowledge?
Is there an automatic presumption that the principle medical-aid member is legally responsible for these shortfalls, under these condition?

Thanx for listening. anyone with valuable input will be appreciated – remember this is strictly a legal question for these circumstances. I don't enjoy these surprise calls. :D
 
Yes you are liable as X is your dependent on your Medical Scheme and Y must sign as you're not there to sign (implied consent). BUT if Y took X to a service provider that is not on the "approved provider list" which would not otherwise generate the shortfall you may be able to say she must pay the difference if she was aware that the medical center is not on the approved list- eg on Plan Delta with Discovery if u use a Hospital outside Delta then there is a R4500 shortfall. If she was not aware then maybe thats a different story. tl;dr Yes

xeslaro said:
Here is a medical aid question:

Facts: (desensitized version)
Child X, my son, is on my medical aid scheme.
Child lives in another province with my ex.
Child requires medical attention.
Mother Y takes child to Medical centre.
Medical centre generates an invoice in which Y presumably signs.
The invoice is processed using my medical aid – Shortfall of R1000.00
Me -totally oblivious - always receives the demand SMS’s and phone-calls from Medical centre because of the non-payment of the shortfall.

My contention is the fact that these situations arise without any knowledge imparted to me, from Y. I receive call from the medicross, my response is ‘I have no idea what you talking about, I am not aware of any medical shortfall nor any visit to your medical centre…” The centre always responds with “but he is on your medical aid” and you must be responsible…. I respond with “I realise such, but it is called a MEDICAL-AID, not called a MEDICAL-TAKE-ALL RESPONSIBILITY-WITHOUT-ANY- KNOWLEDGE-SCHEME”. In my opinion, the medical-aid scheme is merely an insurance scheme, which assists with payment - whereas the entire ‘contract of service’ is between the medical centre and whoever signed the invoice.

Legal Question: (forget the moral Q’s – I know where I stand on this)

Is it legal to generate a statement/invoice in my name?
If so, is it a legal-binding on me if Y signs it without my knowledge?
Is there an automatic presumption that the principle medical-aid member is legally responsible for these shortfalls, under these condition?

Thanx for listening. anyone with valuable input will be appreciated – remember this is strictly a legal question for these circumstances. I don't enjoy these surprise calls. :D
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HavocXphere said:
Source? My med aid gets deducted directly from salary...on the 25th. And is definitely not paid for in advance (covered from 1st Jan, paid them for the first time on 25th).
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Even though you see your medical aid deducted from your salary on the 25th, it doesn't mean that the scheme doesn't get paid earlier in the month. However, perhaps there is some exception that I don't know about for contracts paid by the employer. My source is my own experience - I sell medical aids every now and then.
 
vash87 said:
Even though you see your medical aid deducted from your salary on the 25th, it doesn't mean that the scheme doesn't get paid earlier in the month. However, perhaps there is some exception that I don't know about for contracts paid by the employer. My source is my own experience - I sell medical aids every now and then.
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Quite possible. Perhaps my case isn't exactly representative of the norm. Its a closed industry specific med aid & my employer pretty much lays down the law. e.g. No exclusion periods for anything, no testing for pre-existing conditions whatsoever & the medical aid committed to covering everyone from day 1 before they even knew who or how many they were covering (lol).

Its quite possible that you're spot on & my employer paid a deposit in advance or something. Or maybe it being a closed med aid changes things.

vash87 said:
perhaps there is some exception that I don't know about for contracts paid by the employer.
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I believe from a legal perspective its not the employer paying, but rather me being paid my full salary & the employer takes some of that & transfers it to the med aid on my behalf.
 
HavocXphere said:
Quite possible. Perhaps my case isn't exactly representative of the norm. Its a closed industry specific med aid & my employer pretty much lays down the law. e.g. No exclusion periods for anything, no testing for pre-existing conditions whatsoever & the medical aid committed to covering everyone from day 1 before they even knew who or how many they were covering (lol).
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Group medical scheme deals are quite often free from underwriting and waiting periods etc.. generally only in cases of 20 or more individuals.. depending on the average age of group. It's quite impressive that you guys got the deal before the scheme knew the details of the group.
 
vash87 said:
Group medical scheme deals are quite often free from underwriting and waiting periods etc.. generally only in cases of 20 or more individuals.. depending on the average age of group.
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ah makes sense - because its not the employee making the move thus eliminating the risk of someone making a premeditated move just to claim.

vash87 said:
It's quite impressive that you guys got the deal before the scheme knew the details of the group.
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Its a couple thousand high end med aids covering a super low risk group. No med aid wants to lose that, so they do whatever they are told. :)
 
HavocXphere said:
Its a couple thousand high end med aids covering a super low risk group. No med aid wants to lose that, so they do whatever they are told. :)
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Sounds like the kind of deal I'd like to land one day. The intermediary that set up the contract is probably earning a very sizeable monthly salary from that alone.
 
I found there is a big gap in "gap cover". SO had a small op, hospital R30k, doctor R12k, anaesthetist R9k, then there were x-rays, pathologist. Had to pay R8500 up front at hospital and Doctor demanded full payment in 24 hrs.

Medical Plan (Platinum Focus) covered hospital, less admin fees and the R8500 co-payment, half of doctor and 9/10th of anaesthetist and 0% of x-ray, total shortfall R 14k odd. Gap cover paid R900 of anaesthetist. Said other fees not covered in their plan, since they are not covered in original Medical Plan. Called x-rays and pathologist "out-patient fees" so not covered
 
chrisc4290 said:
I found there is a big gap in "gap cover". SO had a small op, hospital R30k, doctor R12k, anaesthetist R9k, then there were x-rays, pathologist. Had to pay R8500 up front at hospital and Doctor demanded full payment in 24 hrs.

Medical Plan (Platinum Focus) covered hospital, less admin fees and the R8500 co-payment, half of doctor and 9/10th of anaesthetist and 0% of x-ray, total shortfall R 14k odd. Gap cover paid R900 of anaesthetist. Said other fees not covered in their plan, since they are not covered in original Medical Plan. Called x-rays and pathologist "out-patient fees" so not covered
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Medical aid... the silent people who screw you!
 
I don't have medical or hospital plan. Four digit salaries tend to do that. If I get in an accident I'm hoping to either be fine or dead (have R3000 funeral coverage, should help loved ones to cover private cremation).
 
chrisc4290 said:
I found there is a big gap in "gap cover". SO had a small op, hospital R30k, doctor R12k, anaesthetist R9k, then there were x-rays, pathologist. Had to pay R8500 up front at hospital and Doctor demanded full payment in 24 hrs.

Medical Plan (Platinum Focus) covered hospital, less admin fees and the R8500 co-payment, half of doctor and 9/10th of anaesthetist and 0% of x-ray, total shortfall R 14k odd. Gap cover paid R900 of anaesthetist. Said other fees not covered in their plan, since they are not covered in original Medical Plan. Called x-rays and pathologist "out-patient fees" so not covered
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Yes. Gap cover seems to be not worth it to me. Particularly where hospitals or doctors require full payment up front before either medical aid or gap cover has paid out..

And is it the case that you only live submit your gap cover application after the op, and then sit around and wait to find out exactly how much of the gap will actually be covered?
 
phLOx said:
I don't have medical or hospital plan. Four digit salaries tend to do that. If I get in an accident I'm hoping to either be fine or dead (have R3000 funeral coverage, should help loved ones to cover private cremation).
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If you can't afford medical aid, it might be a good idea to at least get your self a bit of dread disease cover from a life insurer, for a fraction the price of a hospital plan.. some of them cover traumatic injuries and accidents etc. That way you'll have some cash available to make things easier if something unfortunate comes up.
 
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