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Medical aid contributions – what you need to know

Every person that joins a medical scheme enters into a legally binding contract.

The terms and conditions of the contract are set out in the application form and the registered rules of the medical scheme.

Medical schemes have two primary sources of income that are used to pay the claims of members: contributions and investments.  If members do not pay contributions it follows that claims cannot be paid by the scheme on behalf of its members.

When are contributions due?

Members of Genesis must pay contributions at the beginning of each month.  Any member that fails to pay contributions on time will be in breach of the contract and will have their membership suspended, meaning that no claims will be admitted whilst membership is suspended.

In cases where contributions remain unpaid by the fourth day of the month, the Scheme will send such defaulting members an email reminding them to pay contributions and warning of the consequences of failing to pay what is due within another fourteen days.

What happens if I don’t pay?

Any member that has not paid all outstanding amounts due to the Scheme by the date specified in the notice, will have their membership terminated due to a material breach of the contract.

How to avoid termination

Quite simply – pay your contribution on time every month.  Failure to do so is a breach of the contract and Genesis is entitled to cancel your membership.  If you are unable to pay your contribution, make a concerted effort to contact the Scheme immediately to try and make an alternative payment arrangement.  Within reason and within certain time limits, the Scheme may be able accommodate your request.

Getting angry and / or resorting to defamatory or false statements on social media when membership is terminated as a result of non-payment of contributions, serve no purpose, especially as the defaulting member is warned after three days that the contribution is outstanding.

All members have a legal obligation to pay their contributions on time.  Whilst some insurance products, i.e. retirement annuities, may allow a contribution holiday(s), there is no provision in the Medical Scheme Act or the rules to allow members to have a contribution holiday.


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