Can my medical aid terminate my membership and reverse my paid bills when I retire?

The long answer

The contribution that an employer pays to the medical aid scheme usually ranges from 30% to 50% of what the employee pays to the medical aid, but as employers are not legally obliged to provide medical aid, they may stop paying their contribution when their employee retires. The employee is then liable to pay for the shortfall if the employer stops paying.

The medical aid cover will only continue for as long as you keep paying the monthly contributions to the medical aid. This is why it’s important to ask the employer if they are going to stop paying their contribution to your medical aid when you retire, before you retire. If you did not ask, your employer may well have stopped paying your contribution.

On whether a medical aid can terminate your membership without giving you an option, The Independent Financial Consultants (IFC) says that “Medical aid schemes may terminate any member’s membership with immediate effect if the member participates in non-disclosure, fraud or if the member belongs to two schemes at the same time.” 

None of the above things would seem to apply to you. 

The Medical Schemes Act no. 131 of 1998 says the following:

"A medical scheme shall not cancel or suspend a member’s membership or that of his/her dependants, except on the grounds of– 

(a) failure to pay, within the time allowed in the medical scheme’s rules, the membership fees required in such rules;

(b) failure to repay any debt due to the medical scheme;

(c) submission of fraudulent claims;

(d) committing any fraudulent act; or

(e) the non-disclosure of material information."

Perhaps the first thing to do is to make an appointment to see the administrator of the medical aid scheme and find out what happened in your case. You could get the contact details from your ex-employer. You should also tell the administrator that it will be extremely difficult for you to pay the reversed bills and discuss what agreement could be reached about it. If they insist on payment, it may be that they would let you pay them back at a reduced rate over a longer time. 

You could also ask the Legal Resources Centre, which offers free legal advice. Here are their contact details:

Website: http://www.lrc.org.za

Phone: 011 038 9709    

Email: info@lrc.org.za

Wishing you the best,
Athalie