Medical Aid Suspended – What does it mean?

Under certain conditions, your membership of a medical aid may be suspended. In the event that this occurs, you should contact your medical aid immediately and find out why they have suspended your membership If they have a valid reason then you should follow their instructions to get your membership reinstated. If your membership was suspended unfairly, then you can contact the Council of Medical Schemes and lodge a complaint against the medical aid company.

Why was my medical aid suspended?

Reasons for Suspension

The most common reasons for being suspended from a medical aid is if :

  • You have not paid your monthly subscriptions/premiums for many months.
  • You were a member of more than one medical aid at the same time.
  • You have been involved in some fraudulent activity with a service provider to ‘defraud money from your medical aid.

There may be other reasons for your suspension and you should speak to your medical aid directly. It is your right to know why your medical aid membership has been suspended and if they will allow you to reinstate your membership if you follow their recommendations. If you have committed fraud, then the medical aid has the right to refuse you membership forever.

What will happen to claims during the suspension period?

No Benefits During Suspension

Your medical aid will not pay for any medical services or medication during the time of your suspension. If you have visited a doctor during this period of suspension and if your doctor has not confirmed membership with your medical aid, you will then be liable for payment of the doctor’s account. Failure to do so can lead your doctor to handing you over to a debt collector which may result in you being ‘blacklisted’ or listed on the credit bureau.

Some medical aids have been known to refuse payment for services during the period when your membership was active since you are now suspended. If you feel that you have a recourse for action on this point, then you should discuss this matter with your lawyer. In the interim, you will have to settle your doctor for the outstanding bill. It is important to remember that medical practitioners do not have a contract with the medical aid. They are simply assisting you with your medical bills and they cannot deal with membership issues on your behalf. Similarly your service provider cannot wait for you to reinstate your membership and you will have to pay you bills in the interim. You can then claim it back from your medical aid once your membership is reinstated. Refer to the article on How To Claim Back From Your Medical Aid.

Can I join another medical aid?

New Medical Aid After Suspension

Yes, you can join another medical aid if your membership has been suspended. However, you will still be liable for outstanding premiums to your previous medical. You may also face medical scheme exclusions from the new medical aid since they will consider you as being a new member with no previous medical cover.

In this instance it is advisable to first settle the matter with your medical aid and get your membership reinstated. If you feel that you would rather join another medical aid, then it is your right to do so after you have reactivated your membership.