What are pre-existing conditions and can they affect my access to benefits?


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Pre-existing conditions refer to any diagnosed medical condition from which either the principal member or any of their dependents may suffer or sustained prior to or at the date of joining the fund. The Board of Trustees reserves the right to impose exclusions or restrictive conditions on pre-existing medical conditions as from the date of joining the Fund and for a period not exceeding 12-months as part of its underwriting criteria. The Fund will not impose exclusions on pre-existing conditions in the event of employees joining the Medical Aid Fund within 3-months after having resigned from a previous medical aid fund. New members wishing to join as private members may be accepted onto the Fund or declined from becoming a member of the Fund based on the results of the underwriting criteria.

 

In the event of a member with a pre-existing medical condition applying for membership with the Fund, the Rules of the Fund provide that exclusions may be imposed subject to the following conditions:

  • In the event of a private member applying for membership, such pre-existing conditions and subsequent treatment thereof may be excluded from cover irrespective of a member previously having been a member of another medical aid fund. Alternatively the application may need to be declined.
  • In the event of a new employee with an existing employer group opting not to take up membership with the Fund within 3-months after being employed, such pre-existing conditions may be excluded since it is regarded as anti-selective behaviour.
  • In respect of a new employer group that has never subscribed to the Fund, the Board of Trustees reserves the right to impose exclusions in respect of pre-existing conditions as part of the underwriting criteria, for a period of 12-months after the initial date of joining. If the new employer group does not agree to this condition then the application for group membership may be declined if the risk to the Fund is deemed to be too high.

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