Is it compulsory for my employer to subsidize my contributions to the medical scheme? No, this is entirely dependant on your employer. Subsidies will form part of your conditions of employment and should be negotiated when agreeing on your initial package. =Can medical schemes base contributions on the basis of individual high claims or provide discounted rates?No, contributions may only be based on a member's income and/or the number of his dependants or both. The contributions apply to all members who are enrolled and their dependants. If I do not claim from 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. What is the National Health Reference Price List (NHRPL)?This is a national price list for health services published by the Council for Medical Schemes and is used by service providers.
If you, as the member of a scheme that pays BHF rates visit any service provider, GP/Specialist etc who charges you above this rate (private rates) you will be liable for the difference. Is a provider of healthcare entitled to charge more than the fees determined by the scheme?Yes healthcare providers are free to determine their own fees. It is therefore always a good idea to first check with the provider what rates they will be charging you. What is a late joiner penalty?This 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.How is this Late Joiner Penalty (ljp) calculated? The ljp is calculated according to a fixed formula that has been determined in the Regulations to the Medical Schemes Act. The longer a person waits to join a medical scheme after the age of 30, the higher the late joiner penalty that will be applied by the scheme.
If you have been a member of a registered medical aid scheme, then this will count in your favour. This is referred to as "creditable coverage" in the relevant legislation. Remember that the scheme will require that you provide proof of such prior medical scheme membership.
To calculate the applicable ljp, the following formula can be used :
A = B minus (35 + C).
"A" is the number of years referred to in Column 1 in the table below.
"B" is the current age of the member,
"C" is the number of years that the member was a member of a registered medical aid scheme (but not including the number of years when the member was a member of a medical scheme as a dependant under the age of 21 years)
|Column 1||Column 2|
|The number of years that the applicant was not a member of a registered medical aid scheme after the age of 30.||Maximum late joiner penalty|
|1 to 4 years||Normal monthly contribution multiplied by 1.05|
|5 to 14 years||Normal monthly contribution multiplied by 1.25|
|15 to 24 years||Normal monthly contribution multiplied by 1.50|
|More than 25 years||Normal monthly contribution multiplied by 1.75|
To demonstrate this with an example :-
· the member is currently 70 years old,
· the member has been an adult member of a previous medical aid scheme for a total of 20 years,
· the normal contribution (before the imposition of the ljp) is R1 200.00 per month.
A = B minus (35 + C)
A = 70 minus (35 + 20)
A = 70 minus 55
A = 15
Now, refer to Column 1 in the table. In this case, the member will therefore have a late joiner penalty of 1.50 times the normal monthly contribution applied to his payment each and every month. The contribution will therefore increase from R1 200 to R1 530 per month.
These calculations can prove to be quite confusing so please give us a call if you need us to explain this in further detail