No such thing as TMI

At Bestmed, the well-being of our members and the responsible management of their risk funds is of the utmost importance to us. Medical schemes, as with insurance companies, deal with risk management that is somewhat based on a “good faith” principle. This means that risk is accepted based on the risk factors declared by the applicant.

It is imperative that applicants complete the membership application form as extensively as possible. They must disclose all information relating to medical treatments, care and/or advice recommended and/or received. This includes healthcare consultations, hospital admissions, chronic medication and home/self-care for the last 12 months prior to application.

It is important to provide the following details as accurately as possible:

  • Date of treatment/care/advice received/recommended,
  • Name of member/dependant who received/was recommended treatment, care and/or advice,
  • Name of medical condition(s), and
  • Treatment prescribed: even if you have stopped treatment without the recommendation of a relevant healthcare practitioner

If the applicant remembers at a later stage that he/she did not provide certain medical information, or if the applicant becomes aware that one of the dependant’s medical information was not disclosed, then the applicant should contact Bestmed and disclose this information as soon as reasonably possible. If the dependant wishes not to disclose certain information directly to the applicant, then the dependant needs to contact Bestmed and disclose such information.

Should the submitted membership application form indicate that no medical treatment/care/advice was received within the past 12 months prior to application, Bestmed may accept the application without any underwriting. There is then no three-month waiting period and no 12-month condition-specific waiting period. However, for the first 12 months, Bestmed will monitor the membership for claims, requests and/or activities that might relate to possible long-standing/pre-existing medical conditions. Should we recognise such related claims/requests/activities, Bestmed will temporarily suspend the membership and investigate the matter.

Should it be determined that the medical condition(s) is/are newly diagnosed, Bestmed will provide funding for the request within the framework of the registered Scheme Rules and the Medical Schemes Act.

On the contrary, should it be determined that the condition is pre-existing and the member failed to disclose this information to Bestmed (whether willingly, knowingly or in ignorance), then the membership will be terminated (as per the provisions of the Medical Schemes Act). At the stage where non-disclosure of material information has been confirmed, Bestmed reserves the right to consider whether the membership will only attract a newly imposed condition-specific waiting period or if the membership will be terminated in full.

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