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Can a medical scheme fire a member for fraud?

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Cape Town - If you failed to tell the whole truth about your medical history in your application, can your scheme  terminate your membership? Not really any more, says the Appeals Board.

The Appeals Committee of the Council for Medical Schemes (CMS), the regulatory body of the medical schemes industry, received an application from Discovery Health Medical Scheme (DHMS) to amend its rules: the rule in question related to the readmission of a medical scheme member after it was found he/she had not disclosed all details of their medical history on their original application forms.

What it comes down to is that even if a member has been found guilty of non-disclosure, and had their membership terminated, they could reapply the next day, and they would have to be accepted, subject to certain waiting periods stipulated in the Medical Schemes Act. But technically criminal charges could still be laid against them.

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