Rules

11. Change of Address of Member

A MEMBER must notify the SOCIETY within 30 days of any change of address including his domicilium citandi et executandi. The SOCIETY shall not be held liable if a MEMBER’s rights are prejudiced or forfeited as a result of the MEMBER’s neglecting to comply with the requirements of this rule.

12. Termination of Membership

12.1 Resignation
12.1.1 A MEMBER, who in terms of his conditions of employment is required to be a MEMBER of the SOCIETY, may not terminate his MEMBERSHIP while he remains an EMPLOYEE without the prior written consent of his EMPLOYER or ASSOCIATED EMPLOYER.
12.1.2 A MEMBER who resigns from the service of the EMPLOYER or ASSOCIATED EMPLOYER shall, on the last calendar day of the termination month, cease to be a MEMBER and all rights to benefits shall thereupon cease, except for claims in respect of services rendered prior thereto.
12.2 Voluntary termination of Membership
The EMPLOYER or ASSOCIATED EMPLOYERS may terminate their participation with the SOCIETY on giving one months written notice.
A MEMBER, who is not required in terms of his conditions of employment to be a MEMBER, may terminate his MEMBERSHIP of the SOCIETY on giving one months’ written notice. All rights to benefits cease after the last calendar day of the notice month.
12.3 Death
MEMBERSHIP of a MEMBER terminates on his death.
12.4 Failure to pay amounts due to the Society
If a MEMBER fails to pay amounts due to the SOCIETY, his MEMBERSHIP may be terminated as provided in these rules.
12.5 Abuse of privileges, False claims, Misrepresentation and Non-disclosure of Factual information
The BOARD may exclude from benefits or terminate the MEMBERSHIP of a MEMBER or DEPENDANT whom the BOARD finds guilty of abusing the benefits and privileges of the SOCIETY by presenting false claims or making a material misrepresentation or non-disclosure of factual information. In such event he may be required by the BOARD to refund to the SOCIETY any sum which, but for his abuse of the benefits or privileges of the SOCIETY, would not have been disbursed on his behalf.

13. Contributions

13.1 The total monthly CONTRIBUTIONs payable to the SOCIETY by or in respect of a MEMBER are as stipulated in Annexure A hereto.
13.2 CONTRIBUTIONs shall be due monthly in advance and be payable by not later than the 3rd day of each month. Where CONTRIBUTIONs or any other debt owing to the SOCIETY, have not been paid within thirty (30) days of the due date, the SOCIETY shall have the right —
13.2.1 to suspend all benefit payments which have accrued to such MEMBER irrespective of when the claim for such benefit arose;
13.2.2 to give the MEMBER at his domicilium citandi et exutandi and/or EMPLOYER or ASSOCIATED EMPLOYERS written notice that if CONTRIBUTIONs or such other debts are not paid up to date within fourteen (14) days of such notice, MEMBERSHIP shall be cancelled.
A notice sent by prepaid registered post to the MEMBER at his domicilium citandi et executandi shall be deemed to have been received by the MEMBER on the 7th day after the date of posting. In the event that the MEMBER fails to nominate a domicilium citandi et executandi, the MEMBER’S postal or residential address on his application form shall be deemed to be his domicilium citandi et executandi.
13.3 In the event that payments are brought up to date, benefits shall be reinstated without any break in continuity subject to the right of the SOCIETY to levy a reasonable fee to cover any expenses associated with the default and to recover interest at the prime overdraft rate of the SOCIETY’s bankers. If such payments are not brought up to date, no benefits shall be due to the MEMBER from the date of default and any such benefit paid may be recovered by the SOCIETY.
13.4 No refund of any assets of the scheme or any portion of a CONTRIBUTION shall be paid to any person where such MEMBER’s MEMBERSHIP or cover in respect of any DEPENDANT terminates during the course of a month.

14. Liabilities of Employer and Member

14.1 The liability of the EMPLOYER or ASSOCIATED EMPLOYERS towards the SOCIETY is limited to any amounts payable in terms of any agreement between the EMPLOYER or ASSOCIATED EMPLOYERS and the SOCIETY.
14.2 The liability of a MEMBER to the scheme is limited to the amount of his unpaid CONTRIBUTIONs together with any sum disbursed by the SOCIETY on his behalf or on behalf of his DEPENDANTs, which has not been repaid to the SOCIETY.
14.3 In the event of a MEMBER ceasing to be a MEMBER, any amount still owing by such MEMBER is a debt due to the SOCIETY and recoverable by it.

15. Claims Procedure

15.1 Every claim submitted to the SOCIETY in respect of the rendering of a Relevant Health Service as contemplated in these rules, must be accompanied by an account or statement as prescribed.
If an account, statement or claim is correct or where a corrected account, statement or claim is received, as the case may be, the SOCIETY must, in addition to the payment contemplated in Section 59 (2) of the ACT, dispatch to the MEMBER a statement containing at least the following particulars-
(a) The name and the MEMBERSHIP number of the MEMBER;
(b) The name of the supplier of service;
(c) The final date of service rendered by the supplier of service on the account or statement which is covered by the payment;
(d) The total amount charged for the service concerned; and
(e) The amount of the benefit awarded for such service.
15.2 In order to qualify for benefits, any claim must, unless otherwise arranged, be signed and certified as correct and must be submitted to the SOCIETY not later than the last day of the fourth month following the month in which the service was rendered.
15.3 Where a MEMBER has paid an account, he shall, in support of his claim, submit a receipt.
15.4 Accounts for treatment of injuries or expenses recoverable from third parties, must be supported by a statement from the MEMBER, setting out particulars of the circumstances in which the injury or accident was sustained.
15.5 Where the SOCIETY is of the opinion that an account, statement or claim is erroneous or unacceptable for payment, the SOCIETY shall notify the MEMBER or the health care provider, whichever is applicable, accordingly within 30 days after receipt thereof. The SOCIETY shall state the reasons why such claim is erroneous or unacceptable and afford such MEMBER or provider the opportunity to return such corrected claim to the SOCIETY within sixty days following the date from which it was returned for correction.