6. MEMBERSHIP
6.1 “Eligibility”
Membership of the Scheme is restricted to:-
6.1.1 all Persons
eligible for membership of the Professional Provident Society of
South Africa (hereinafter referred to as the PPS); and
6.1.2 all full-time Employees of the Scheme or
Professional Provident Society Insurance Company Limited and its
subsidiaries.
6.2 “Pensioners”
6.2.1 A Member shall
retain his membership of the Scheme with his registered Dependants,
if any, in the event of his retiring from the service of his
employer or his employment being terminated by his employer on
account of age, ill-health or other disability, or he retires from
practising his profession;
6.2.2 The Scheme shall inform the Member of his
right to continue his membership and of the Contribution payable
from the date of retirement. 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 were admitted and registered with the Scheme as
such at the time of such Member’s death shall be entitled to
membership of the Scheme without any new restriction, limitation or
Waiting Period;
6.3.2 The Scheme 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 remain a Member of the
Scheme;
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 Child Dependants have been orphaned,
the oldest sibling shall be classified as the Member paying Child
Dependant rates but subject to the provision of rules 4.15.2 and
4.15.3, and the younger siblings shall qualify as Child Dependants,
subject to the provisions of the rules.
7.REGISTRATION AND DEREGISTRATION OF DEPENDANTS
7.1 “Registration of Dependants”
7.1.1 A Member may apply
for the registration of any one or more of his Dependants at the
time that he applies for membership in terms of rule 8 or subject to
rule 7.1.2, at anytime thereafter;
7.1.2 If a Member applies to register a newborn or
newly adopted Child within thirty (30) days of the date of birth or
adoption of the Child, such Child shall thereupon be registered by
the Scheme as a Dependant. Increased Contributions shall then be due
as from the first day of the month following the month of birth or
adoption and benefits will accrue as from the date of birth or
adoption;
7.1.3 If a Member who marries subsequent to joining
the Scheme applies within thirty (30) days of the date of such
marriage to register his Spouse as a Dependant his Spouse shall
thereupon be registered by the Scheme as a Dependant. Increased
Contributions shall then be due as from the first day of the month
following the month of marriage and benefits will accrue as from the
date of marriage; and
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 Scheme for
the registration of such person as a Dependant, whereupon the
provisions of rule 8 shall apply mutatis mutandis.
7.2. “Deregistration of Dependants”
7.2.1 A Member shall
inform the Scheme within thirty (30) days of the occurrence of any
event which 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 as
such, 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; and
7.2.3 Subject to rule 6.3 the membership of a
Dependant shall terminate immediately once the membership of the
principal Member is terminated for any reason.
8.TERMS AND CONDITIONS APPLICABLE TO MEMBERSHIP
8.1 No person may:
8.1.1 be a Member of more
than one Medical Scheme;
8.1.2 be a Dependant of more than one Member of a
particular Medical Scheme;
8.1.3 be a Dependant of Members of different
Medical Schemes; or
8.1.4 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 or a Dependant of a Member;
8.2 A prospective Member shall, prior to admission, complete and submit the application forms required by the Scheme, together with copies of Identification Documents and/or Birth Certificates or other satisfactory evidence of age, Income, state of his health and the health of his Dependants and of any medical advice, diagnosis, care or treatment recommended or obtained within a period of twelve (12) months immediately prior to the date on which application to the Scheme was made. Proof of any prior membership of any other Medical Scheme must also be submitted.
8.3 Waiting Periods:
8.3.1 The Scheme 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 ninety (90) days preceding the date of application:
8.3.1.1 a General Waiting
Period of up to three (3) months; and
8.3.1.2 a Condition-Specific Waiting Period of up
to twelve (12) months.
8.3.2 The Scheme 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 twenty-four (24) months, terminating less than ninety (90) days immediately prior to the date of application:
8.3.2.1 a
Condition-Specific Waiting Period of up to twelve (12) months,
except in respect of any treatment or diagnostic procedures covered
within the Prescribed Minimum Benefits;
8.3.2.2 in respect of any person contemplated in
this subrule, 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.
8.3.3 No Waiting Period may be imposed as a result of:
8.3.3.1 change of
employment;
8.3.3.2 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 (three) 3 months
notice must have been furnished to the Scheme to which an
application is made for such transfer to occur at the beginning of
the financial year;
8.3.3.3 a Beneficiary who changes from one benefit
option to another within the Scheme unless the Beneficiary is
subject to a Waiting Period on the current benefit option in which
case the remaining period may be applied;
8.3.3.4 a Child Dependant born during the period of
membership.
8.4 The registered Dependants must participate in the same benefit option as the Member;
8.5 Every Member will, on admission to membership, receive a detailed summary of these rules which shall include Contributions, benefits, limitations, and 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; and
8.6 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 Scheme. The Scheme 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, pledge, or hypothecate such benefit.
9.1 The Board shall admit to membership of the Scheme, without a waiting period or imposition of new restrictions on account of the state of his health or the health of any of his Dependants, any person who has been a member or the dependant of a member of any other registered Medical Scheme for a continuous period of at least two (2) years and who applies within three (3) months after the date on which he ceased to be a member or a dependant of such scheme, to become a Member or a Dependant; and
9.2 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 this Scheme, the Board will admit as a Member, without a Waiting Period or the imposition of new restrictions on account of the state of his health or the health of any of his Dependants, any member of such first-mentioned scheme who is a Member or Continuation Member by virtue of his past employment with the particular employer and register as Dependant any person who has been a registered dependant of such employee of the particular employer.
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 Scheme and must be returned to the Scheme 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 benefits of the Scheme which shall entitle the Scheme, in addition to any other remedies it may have, to apply the provisions of rule 12.5; and
10.3 On termination of membership or on de-registration of a Dependant, the Scheme must within thirty (30) days of such termination, furnish such person with a certificate of membership and cover, containing such particulars as may be prescribed.
