Medical Schemes Act, 1998 (Act No. 131 of 1998)RegulationsRegulations in terms of the Medical Schemes ActChapter 4 : Waiting periods and premium penalties13. Premium penalties for persons joining late in life |
| 1) | A medical scheme may apply premium penalties to a late joiner and such penalties must be applied only to the portion of the contribution related to the member or any adult dependant who qualifies for late joiner penalties. |
| 2) | The premium penalties referred to in subregulation (1) shall not exceed the following bands : |
Penalty Bands |
Maximum penalty |
1 - 4 years 5 - 14 years 15 - 24 years 25 + years |
0.05 x contribution 0.25 x contribution 0.5 x contribution 0.75 x contribution |
| 3) | To determine the applicable penalty band to be applied to a late joiner in terms of the first column of the table in subregulation (2), the following formula shall be applied : |
A = B minus (35 + C)
where:
"A" means the number of years referred to in the first column of the table in subregulation (2), for purposes of determining the appropriate penalty band;
"B" means the age of the late joiner at the time of his or her application for membership or admission as a dependant; and
"C" means the number of years of creditable coverage which can be demonstrated by the late joiner.
| 4) | Where an applicant or his or her dependant produces evidence of creditable coverage after a late joiner penalty has been imposed, the scheme must recalculate the penalty and apply such revised penalty from the time such evidence is provided. |
| 5) | Late joiner penalties may continue to be applied upon transfer of the member or adult dependant to other medical schemes. |
| 6) | For the purposes of subregulations (3) and (4), it shall be sufficient proof of creditable coverage if the applicant produces a sworn affidavit in which he or she declares — |
| a) | the relevant periods in which he or she was a member or dependant and the name or names of the relevant medical schemes or other relevant entities corresponding with such period or periods; and |
| b) | that reasonable efforts have been made to obtain documentary evidence of such periods of creditable coverage, but have been unsuccessful. |
| 7) | A medical scheme must report annually to the Registrar on the number of late joiners enrolled in each band during the previous year and cumulatively. |
| 8) | For the purposes of subregulations (3) and (4), it shall be sufficient proof of creditable coverage if the applicant produces a sworn affidavit in which he or she declares – |
| a) | the relevant period or periods in which he or she was a beneficiary and the name or names of the relevant medical scheme or medical schemes corresponding with such period or periods; and |
| b) | that reasonable efforts have been made to obtain documentary evidence of such periods of creditable coverage, but have been unsuccessful. |