Rules

6. Membership

6.1 Eligibility
Subject to rule 8, MEMBERSHIP of the SOCIETY is restricted to:
Employment and former employment as provided for hereunder, with the EMPLOYER or ASSOCIATED EMPLOYERS or their successors in title as defined in these rules, and is either voluntary or compulsory dependent on the EMPLOYEE’s conditions of employment and may include participants on the EMPLOYER OR ASSOCIATED EMPLOYER’s bursary scheme.
6.2 Retirees
6.2.1 A MEMBER shall retain his MEMBERSHIP of the SOCIETY with his registered DEPENDANTs, if any, in the event of his retiring from the service of his EMPLOYER or ASSOCIATED EMPLOYER or his employment being terminated by his EMPLOYER or ASSOCIATED EMPLOYER on account of age, ill-health or other disability.
6.2.2 The SOCIETY shall inform the MEMBER of his right to continue his MEMBERSHIP and of the CONTRIBUTION payable from the date of retirement or termination of his employment. Unless such MEMBER informs the BOARD in writing of his desire to terminate his MEMBERSHIP, he shall continue to be a MEMBER.
6.3 Dependants of deceased Members
6.3.1 The DEPENDANTS of a deceased MEMBER who are registered with the SOCIETY as his DEPENDANTs at the time of such MEMBER’s death, shall be entitled to MEMBERSHIP of the SOCIETY without any new restrictions, limitations or waiting periods.
6.3.2 The SOCIETY shall inform the DEPENDANT of his right to MEMBERSHIP and of the CONTRIBUTIONs payable in respect thereof. Unless such person informs the BOARD in writing of his intention not to become a MEMBER, he shall be admitted as a MEMBER of the SOCIETY.
6.3.3 Such a MEMBER’s MEMBERSHIP terminates if he becomes a member or a dependant of a member of another medical scheme.
6.3.4 Where a CHILD DEPENDANT/s has been orphaned, the youngest CHILD may be deemed to be the MEMBER, and any older siblings, the CHILD DEPENDANT/s.
6.4 Retrenchment
A MEMBER who is retrenched from the services of the EMPLOYER or Associated Employer may continue MEMBERSHIP of the SOCIETY, provided:
6.4.1 the MEMBER is not entitled to MEMBERSHIP of another medical scheme by virtue of his employment; and
6.4.2 the Society is entitled to terminate the membership of such member should it become aware that he has secured permanent employment with any employer other than the EMPLOYER OR ASSOCIATED EMPLOYERS.

7. Registration and De-registration of Dependants

7.1 Registration of Dependants
7.1.1 A MEMBER may apply for the registration of his DEPENDANTs at the time that he applies for MEMBERSHIP in terms of rule 8.
7.1.2 If a MEMBER applies to register a new born or newly adopted CHILD within three months of the date of birth or adoption of the CHILD, such CHILD shall thereupon be registered by the SOCIETY as a DEPENDANT. Increased CONTRIBUTIONs and benefits will be due or accrue respectively as from the date of birth or adoption.
7.1.3 If a MEMBER who marries subsequent to joining the SOCIETY, applies within three months of the date of such marriage to register his SPOUSE as a DEPENDANT, his SPOUSE shall thereupon be registered by the SOCIETY as a DEPENDANT. Increased CONTRIBUTIONs and benefits will be due or accrue respectively as from the date of marriage.
7.1.4 In the event of any person becoming eligible for registration as a DEPENDANT other than in the circumstances set out in rules 7.1.1 to 7.1.3, the MEMBER may apply to the SOCIETY for the registration of such person as a DEPENDANT, whereupon the provisions of rule 8 shall apply mutatis mutandis.
7.2 De-registration of Dependants
7.2.1 A MEMBER shall inform the SOCIETY within 30 days of the occurrence of any event that results in any one of his DEPENDANTs no longer satisfying the conditions in terms of which he may be a DEPENDANT.
7.2.2 When a DEPENDANT ceases to be eligible to be a DEPENDANT, he shall no longer be deemed to be registered as such for the purpose of these rules or entitled to receive any benefits, regardless of whether notice has been given in terms of these rules or otherwise.

8. Terms and Conditions Applicable to Membership

8.1 A minor may become a MEMBER with the consent of his parent or guardian.
8.2 No person may be a MEMBER of more than one medical scheme or a DEPENDANT:
8.2 1 of more than one MEMBER of a particular medical scheme; or
8.2.2 of MEMBERs of different medical schemes or;
8.2.3 claim or accept benefits in respect of himself or any of his DEPENDANTs from any medical scheme in relation to which he is not a MEMBER.
8.3 Prospective MEMBERS shall, prior to admission, complete and submit the application forms required by the SOCIETY, together with satisfactory evidence in respect of himself and his DEPENDANTS, of age, INCOME, state of his health and of any prior membership or admission as dependant of any other medical scheme. The SOCIETY may require an applicant to provide the SOCIETY with a medical report in respect of any proposed BENEFICIARY in respect of a condition for which medical advice, diagnosis, care or treatment was recommended or received within the twelve-month period ending on the date on which an application for membership was made.
8.4 Waiting periods
8.4.1 The SOCIETY may impose upon a person in respect of whom an application is made for membership or admission as a DEPENDANT, and who was not a BENEFICIARY of a medical scheme for a period of at least 90 days preceding the date of application –
8.4.1.1 a GENERAL WAITING PERIOD of up to three months; and
8.4.1.2 a CONDITION SPECIFIC WAITING PERIOD of up to 12 months.
8.4.2 The SOCIETY may impose upon any person in respect of whom an application is made for membership or admission as a DEPENDANT, and who was previously a BENEFICIARY of a medical scheme for a continuous period of up to 24 months, terminating less than 90 days immediately prior to the date of application –
8.4.2.1 a CONDITION SPECIFIC WAITING PERIOD of up to 12 months, except in respect of any treatment or diagnostic procedures covered within the prescribed MINIMUM BENEFITS;
8.4.2.2 in respect of any person contemplated in this sub-rule, where the previous medical scheme had imposed a GENERAL or CONDITION SPECIFIC WAITING PERIOD, and such waiting period had not expired at the time of termination, a GENERAL or CONDITION SPECIFIC WAITING PERIOD for the unexpired duration of such waiting period imposed by the former medical scheme.
8.4.3 The SOCIETY may impose upon any person in respect of whom an application is made for membership or admission as a DEPENDANT, and who was previously a BENEFICIARY of a medical scheme for a continuous period of more than 24 months, terminating less than 90 days immediately prior to the date of application, a GENERAL WAITING PERIOD of up to 3 months, except in respect of any treatment or diagnostic procedures covered within the prescribed MINIMUM BENEFITS.
8.5 No waiting periods may be imposed on:
8.5.1 a person in respect of whom an application is made for membership or admission as a DEPENDANT, and who was previously a BENEFICIARY of a medical scheme, terminating less than 90 days immediately prior to the date of application, where the transfer of membership is required as a result of –
8.5.1.1 change of employment; or
8.5.1.2 an employer changing or terminating the medical scheme of its employees, in which case such transfer shall occur at the beginning of the financial year, or reasonable notice must have been furnished to the scheme to which an application is made for such transfer to occur at the beginning of the year.
Where the former medical scheme had imposed A GENERAL or CONDITION SPECIFIC WAITING PERIOD in respect of persons referred to in this rule, and such waiting period had not expired at the time of termination of membership, the SOCIETY may impose such waiting period for the unexpired duration of a waiting period imposed by the former scheme.
8.5.2 a child DEPENDANT born during the period of membership.
8.6 Every MEMBER will, on admission to MEMBERSHIP, receive a detailed summary of these rules, which shall include CONTRIBUTIONs, benefits, limitations, the MEMBER’s rights and obligations. MEMBERs and their DEPENDANTs, and any person who claims any benefit under these rules or whose claim is derived from a person so claiming are bound by these rules as amended from time to time
8.7 A MEMBER may not cede, transfer, pledge or hypothecate or make over to any third party any claim, or part of a claim or any right to a benefit which he may have against the SOCIETY. The SOCIETY may withhold, suspend or discontinue the payment of a benefit to which a MEMBER is entitled under these rules, or any right in respect of such benefit or payment of such benefit to such MEMBER, if a MEMBER attempts to assign or transfer, or otherwise cede or to pledge or hypothecate such benefit.

9. Transfer of Employer Groups from another Medical Scheme

If the members of a medical scheme who are members of that scheme by virtue of their employment by a particular employer, terminate their membership of such scheme with the object of obtaining MEMBERSHIP of the SOCIETY, the BOARD will admit as a MEMBER, without a waiting period, any member of such first-mentioned scheme who is a CONTINUATION MEMBER by virtue of his past employment by the particular employer and admit any person who has been a registered DEPENDANT of such member, as a DEPENDANT.

10. Membership Card and Certificate of Membership

10.1 Every MEMBER shall be furnished with a membership card, containing such particulars as may be prescribed. This card must be exhibited to the supplier of a service on request. It remains the property of the SOCIETY and must be returned to the SOCIETY on termination of MEMBERSHIP.
10.2 The utilisation of a MEMBERSHIP card by any person other than the MEMBER or his registered DEPENDANTs, with the knowledge or consent of the MEMBER or his DEPENDANTs is not permitted and is construed as an abuse of the privileges of MEMBERSHIP of the SOCIETY.
10.3 On termination of MEMBERSHIP or on de-registration of a DEPENDANT, the SOCIETY must, within 30 days of such termination, furnish such person with a certificate of MEMBERSHIP and cover, containing such particulars as may be prescribed.