Rules for membership

» Discovery Health Medical Scheme rules for membership

» Discovery Vitality rules for membership

» Financial adviser’s declaration

Discovery Health Medical Scheme - Rules for membership 

12.1 Rules for membership

Rules for membership are the rights and responsibilities for your membership of the Scheme. They may change from time to time. You may ask us for a copy at any time.

When you sign your application, you confirm that you have read and understood the rules and you agree that you and those you apply for will be bound by them. You also acknowledge and appoint your employer’s contracted financial adviser for all matters relating to your membership of the Discovery Health Medical Scheme

12.2 Who you are applying for

You may apply to join the Scheme on your own or together with other people – your spouse, your partner, and people who are financially dependent on you. To be treated as financially dependent for this application, a dependant must earn an income of less than what is stated

in the Scheme rules, or you must have a legal responsibility to provide financially for them. We might ask you to give us proof of financial or legal responsibility.

You will be called the principal member or main member in our future communications to you.

12.3 Acting for others

You confirm you have the right to act for others

By signing your application, you confirm that:

• you have the right to apply for membership and to act for those you apply for in any matter relating to this application.
• you have received permission from your spouse and any dependants over 21 to act for them in any matter relating to this application.

12.4 Giving information

You must give us true, correct and complete information

To consider your application for membership, the Scheme must learn more about you and those you apply for.

Information about you and those you apply for must be true, correct and complete. This includes the details you give in your application form and in future dealings with us. It is important that you tell us about any medical condition, symptom or illness relating to you or those you apply for even if you do not consider it relevant to your application.

We may ask those you apply for who are 21 and older for information and it will be treated as if we had asked you in your role as main member.

We may get information from other relevant sources

To consider your application for membership, conduct underwriting or risk assessments or to consider a claim for medical expenses, you agree that we and the Scheme can get information about you and those you apply for from other relevant sources. These include any entity that is part of Discovery Holdings Limited, medical practitioners, financial advisers, credit bureaus or industry regulatory bodies. We and the Scheme may (at any time and on an ongoing basis) verify with the parties mentioned in this section that the information you give on this application and in respect of any matter pertaining to or that arose during your membership of the Scheme, is true, correct and complete.

I give my permission that the Scheme may get any information that is relevant to my application from my employer. This permission ends on the day that my cover with the Scheme starts.

Tell us about changes right away

If any of the information you gave to us changes between the day you sign your application and the day your membership starts, you must tell us in writing what the changes are. This includes information about your health and the health of those you apply for.

When the Scheme may cancel

The Scheme may cancel any memberships immediately and keep any contributions paid, if you and those you apply for:

• do not give us information that later turns out to be relevant to your application.
• give us any information that is not true, correct and complete.
• do not tell us about any relevant changes (including about your health and the health of those you apply for) between the day you sign your document and the day cover starts.

12.5 Sharing information and confidentiality

When we may share your information

We and the Scheme will keep your information and the information about those you apply for confidential. We and the Scheme may share this information with other relevant parties only if the following conditions are met:

1. The information:
   • is needed only to administer the Scheme and any claims; or
   • is requested by a party who you have already given your consent to for the disclosure of this information.
2. The party we and the Scheme share the information with agrees to keep the information confidential.

If we want to share your information for any other reason, we will do so only with your permission.

We and the Scheme may record calls

We and the Scheme may record telephone conversations with you and with those you apply for.

The recordings and all information we get during the recordings will be processed and kept as required by law.

12.6 About becoming a member

We will consider your application

We will consider your application and any one of the following will happen:

• we will accept you on these terms; or
• we will send a letter with revised terms; or
• we will let you know that we need more information about you andthose you apply for before your cover can start.

We might not pay for certain expenses immediately

The Scheme may have waiting periods that apply in certain circumstances. This means there may be a set time period before we start paying for any general or specific medical conditions. Please speak to your financial adviser or us to find out if waiting periods apply to your membership and the memberships of those you apply for.

Resign from current medical schemes when accepted

It is illegal to be a member of more than one medical scheme at the same time. You and those you apply for must resign from your current medical schemes when you receive notice from the Scheme by letter, email or SMS telling you that you and those you apply for have been accepted.

You must ensure contributions are paid on time

As the main member of the Scheme, you are responsible for ensuring that your contributions and the contributions of those you apply for are paid on time every month.

12.7 Repaying medical savings if you leave

You must repay any medical savings owing if you leavethe Scheme

When you become a member, depending on the plan you chose, you may have money available in advance to use for medical expenses during the year. This money is made available in an account called the ‘Medical Savings Account’. If you leave the Scheme before the year is up, you must repay the portion of medical savings you have used that is more than you have paid back to the Scheme over the year.

Discovery Vitality - Rules for membership 

Discovery Vitality is separate from the Scheme and administrator

Discovery Vitality is a separate company from Discovery Health (Pty) Ltd (‘the administrator’) and the Discovery Health Medical Scheme (referred to as ‘the Scheme’). It is formally registered under the name Vitality HealthStyle (Pty) Ltd, (registration number 1999/007736/07) and takes care of the administration of the Vitality programme (‘Discovery Vitality’), DiscoveryCard and the DiscoveryCard Loyalty Programme.

Rules of the Vitality programme

A full set of rules is available from Discovery Vitality on request. In the event of a conflict between what is set out here, on our website and the rules of Vitality, the rules will always apply.

Your contributions to Discovery Vitality are separate

The contributions you pay to Discovery Vitality are not part of the contributions you pay to the Scheme.

Permission to get information from the Scheme

You specifically give Discovery Vitality permission to get the relevant information from the Scheme in order to administer the Vitality programme and to increase our product offering to you.

Sharing your information

Discovery Vitality will keep your information and the information about those you apply for confidential. Discovery Vitality may share this information and information about your membership with other relevant parties, including your employer, only if the following two conditions are met:

1. The information is needed only to administer and promote the Vitality programme. This includes asking for and sharing details about your credit standing and the credit standing of those you apply for with any credit bureau in line with the requirements of the National Credit Act.
2. The parties Discovery Vitality share the information with will agree to keep the information confidential.

Financial adviser’s declaration

1. I am an accredited financial adviser in terms of the Medical Schemes Act and licensed by the FSB in terms of the FAIS Act at the date of signing this application form.
2. I am appointed by the client to provide advice about this application.
3. I have a valid contract with the Scheme and I have made the client aware of the commission payable by Discovery Health Medical Scheme.
4. I am responsible for providing the applicant with:
   • my name, physical address, postal address and telephone number
   • impartial advice that is in his or her best interest.
5. I am accountable for any advice given to the member about completion of this application form and joining the Scheme.