Guiding consumers since 2009

Featured question: If I miss a payment, am I still covered?

By Staff Writer
Question:
 
If I miss a health insurance payment, am I still covered? What is the grace period for being late?
 
Answer:
 
The Medical Schemes Act cites failure to pay the premium in the time allowed as one of the grounds for suspension of a member.
 
Technically, a member who does not pay their premiums is no longer a member and a scheme is not permitted to provide benefits for a non-member. This is because a scheme's funds are made up of the members' contributions for the benefit of said members, and therefore unfair to those members if that scheme were to provide benefits for someone not contributing.
 
However, there are obviously situations where contributions are missed or paid late for various reasons. Therefore, if a member has missed a payment, I would suggest that they contact their scheme as soon as possible to explain the situation and attempt to make the necessary arrangements to avoid the possibility of being denied benefits.
 
Expert:
 
After working in the NGO sector for several years, Heidi joined the Board of Healthcare Funders in 2000 as Head of Corporate Communications. For more information, click here.

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