What is a co-payment? 
It is a portion of the cost for which you are responsible.

Can a minor become a member?
Yes, with the assistance of his/her parents or guardian, provided that the relevant contributions are paid by him/her or on his/her behalf.

If a member dies, will his/her dependants still be covered?
Yes, without any break in membership and provided contributions are paid. It is important to inform the scheme if one chooses not to continue with the medical aid scheme.

Must I give notice to the scheme in the event that I wish to terminate membership?
Yes, the notice period stipulated in the rules must be complied with.

Am I entitled to benefits while serving notice of termination?
Yes, until the last day of membership provided contributions are being paid.

Is my scheme entitled to cancel my membership when the employer fails to pay the membership fees?
Yes, since the employer pays the contributions on behalf of its employees and since the scheme has a contract with the member. The Scheme must give the employer and or/member written notice that if the contributions are not paid up within the stipulated period as per policy rules, membership may be cancelled.

May pensioners’ contributions be less than that of other members?
No, contributions to a medical scheme may only be based upon a member’s income and/or his number of dependants.

If I do not claim against my medical scheme, may I receive a no-claim bonus or rebate?
No, the Act prohibits the payment of bonuses, rebates or re-funding of any portion of contributions other than in respect of savings accounts in certain circumstances.

On what basis may contributions vary?
Only in respect of the cover provided. Different benefit options/plans are priced differently depending on the level of cover afforded.
If the rules of the scheme so provide, children may be charged a reduced contribution.

What can I do if I am not satisfied with my current benefit option?
Instead of changing schemes and be faced with waiting periods, a member can either buy up in order to get better benefits or buy down for less contributions.

What is a designated service provider (DSP)?
A healthcare provider or group of providers selected by the scheme as the preferred provider or providers to provide to its members diagnosis, treatment and care in respect of one or more prescribed minimum benefit conditions.

What are the types of waiting periods?
General waiting period of up to three months.
Condition-specific waiting period of up to 12 months.

When do such waiting periods not apply?
Prescribed minimum benefits other than specified in Q28
A child dependant born during the period of membership
A member moving between benefit options unless he has to complete the remaining period of previously imposed waiting periods.
When an individual has to involuntarily transfer to another scheme due to a change of employment.
In instances where an employer changes the medical scheme of his employees with effect from the beginning of the financial year.

What is a late joiner penalty?
It is a penalty by way of additional contributions, imposed on persons joining a scheme late in life i.e. an applicant who is 35 years of age or older who was not a member of one or more medical schemes as from a date preceding 01 April 2001 without a break in coverage exceeding three consecutive months since 01 April 2001.

Can a medical scheme impose a condition-specific waiting period on pregnancy?
Yes, in those instances where the person was a beneficiary of a medical scheme for up to 24 months.

How do I know whether or not my scheme has paid and what amount has been paid in respect of a claim?
Payment of claims is regulated by the Act, which includes the dispatch to a member of a statement containing full particulars of the transaction, including the amount charged for every service and the amount of the benefit awarded for each service.

Within what period of time must the scheme pay my claim?
If the account or claim is correct and acceptable for payment, it should be paid within 30 days of receipt of the claim.

Why do my day-to-day benefits get exhausted so quickly?
It will be different response for different cases. Could be member on chronic but not registered, member went to a specialist and was charged above scheme rates.

Where do I register for authorization?
Contact us on 0860 007 280 to assist you by requesting the authorization from the schemes during working hours.

How do I register my dependents?
Contact us to assist with registrations for different schemes.

Why was my claim not paid or short-paid?
There are different reasons as to why this is. Your funds might be exhausted. For further assistance contact us on 0860 007 280.

Where do I submit my claim?
Each scheme we work with has CHM or Consultant that we assist us in solving claims queries timelessly.

How do I check the status of my application?
Contact us on 0860 007 280 to check your application status and for any questions regarding your application.


VALUE ADDED SERVICE

Mpumelelo Services will always be available to assist you when you need us most, but we respectfully request that you also play your part. Following the tips and guidelines below will ensure world class service in the unfortunate event of a claim. Here are a few tips to make sure you’re properly covered and ensure that any claims are settled as quickly as possible. 

Update your details 
We need to know about changes in risk, personal contact and banking details.

Read your policy carefully 
Please make sure that you fully understand the terms and conditions of your insurance policy and feel free to call us if you have any queries. 

Check your premiums 
It is solely your responsibility to ensure that your premiums are paid on time. 

Check your premiums 
It is solely your responsibility to ensure that your premiums are paid on time. 

Review your policy regularly 
With the exception of motor vehicles, all items are insured at replacement value so please make sure you’re properly covered. Settlement in case of a stolen or written off vehicle will be based on retail value, so please include any extras fitted to the vehicle. Make sure that you review this amount regularly as vehicles depreciate over time. 

 Review your policy regularly 
With the exception of motor vehicles, all items are insured at replacement value so please make sure you’re properly covered. Settlement in case of a stolen or written off vehicle will be based on retail value, so please include any extras fitted to the vehicle. Make sure that you review this amount regularly as vehicles depreciate over time. 

Burglar proofing/alarm 
Ensure that all doors and windows are secured with security gates and burglar proofing. It is up to you to regularly test that your alarm and security response system is in good working order. Please confirm a test beforehand with your security response provider rather than pressing the panic button as this may lead to an unfortunate situation should the armed officers think that the test is a live situation. 

 All-risk 
Please remember that cover is limited for personal items outside of the home. It is therefore very important that you specify high value items such as laptops, tablets, phones, jewellery, cameras, bicycles and the like. 

Roadworthiness 
It’s up to you to ensure that your vehicle is in good working order at all times. In particular, the tyres must be in a legal roadworthy condition and the licence must be up to date. Further, for your own safety and the very possible repudiation of a claim, please NEVER drive under the influence