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Updated 02 February 2013

Medical schemes discriminate, says commission

The National Consumer Commission wants "discriminatory" rules in medical schemes to be declared unconstitutional.

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The National Consumer Commission wants "discriminatory" rules in medical schemes to be declared unconstitutional, The Sunday Independent reported.

According to the report medical aid schemes were sexist towards pregnant women and discriminated against foreigners. The commission had turned to the Equality Court, where it was challenging four of South Africa's top medical aids and the Council for Medical Schemes.

The commission pointed to certain "discriminatory" clauses that technically excluded women who fell pregnant before they joined the schemes from benefiting from the medical aid.

The respondents in the case were the council, Medscheme, which is an administrator of Bonitas and Fedhealth, Momentum Health and Medshield. Bonitas and Fedhealth were also respondents.

Director of legal services at the commission, Oatlhotse Thupayatlase, told the newspaper that when the Council for Medical Schemes was asked about the clauses it said they protected the schemes from "free riders" or people who took out medical aid schemes when they knew that they were pregnant and wanted to benefit.

Last June 2011, the commission asked random medical aid schemes to submit their rules for investigation to see if they complied with the Consumer Protection Act.

It found that each medical aid had clauses stipulating a three-month general waiting period when someone joined and a "condition specified" waiting period of up to 12 months.

In its court papers the commission said: "The commission submitted to the schemes that the waiting period of three months and exclusion of 12 months for a condition that was there within three months of taking the cover, refers to 'pregnancy'.

"That being the case, it meant that the said clauses are discriminatory based on gender."

Medscheme argued on behalf of Fedhealth and Bonitas that the reason for the waiting period was to protect the scheme from people who joined with the aim of undergoing an expensive procedure and then resigned afterwards.

(Sapa, July 2012)

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