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Medical Aid – Can you have two Medical Aids?

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Is Membership of More Than One Medical Aid Scheme Permitted?

Anyone familiar with the way in which medical aids operate will easily realise the possible advantages that might be gained if you have managed to enrol yourself in two schemes. For a start, in the event that the benefits offered under the first scheme should be become exhausted, then it would be of immense value to be able to simply submit any additional claims that might arise subsequently, to the second insurer. However, as valuable as this option may appear, if you should attempt to do so, under the terms of section 28 of the Medical Schemes Act which applies to the industry in South Africa, you would be deemed guilty of fraud and at risk of criminal prosecution.

While you may well have no deliberate intention of defrauding a scheme, a word of warning may be in order. It is actually quite possible for you to find yourself in the position of having membership of two medical aids quite unintentionally. Let us consider a hypothetical case in which your healthcare expenses are currently being covered by a scheme in which your spouse is the main member. At some stage, you could be offered a more attractive post with another company where you are required to enrol in their closed group scheme. If you, inadvertently, overlook your legal obligation to cancel your dependent membership of your spouse’s scheme, you would, in fact, be guilty of fraud.

In practice, the new scheme’s terms require you to disclose membership of any other fund and failure to do so, could result in termination or suspension of your membership. More seriously though, intentional or otherwise, having two medical aids could see you found guilty of fraud and faced with a custodial sentence of up to 5 years. It doesn’t end there, however. Your name could be included in a fraud database and this could see you refused health insurance in the future. By contrast, it is fine to be a member of a scheme and to purchase gap cover or payment protection insurance.

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