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The pro-ration of medical aid benefits

Many medical aid schemes have annual limits that apply to certain benefits.  The idea is that the member is entitled to use that benefit for the entire year to the limit set.  In order to protect members of a medical scheme from abuse, the Registrar of Medical Schemes permits the pro-ration of benefits that will apply to anybody joining a medical scheme during the year.  This makes perfect sense as it will be grossly unfair if a member can join mid-year and the get the same benefits as a member that has been contributing for the full year.

There would be nothing to stop a member joining Medical Scheme A in January, using all the annual benefits during the first four months and then joining Medical Scheme B in May and using the entire year’s benefits of that scheme.  Members joining in, say, November, cannot reasonably expect the same annual limits that apply to members contributing for the entire year.

Therefore, Genesis has a registered rule that provides that wherever benefits have an annual limit, a member joining the scheme during the year will be allowed a proportion of the benefit that remains, calculated from the time membership begins, until the end of that particular financial year.

If in any doubt, you are welcome to call Genesis on 0860 10 20 10.

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