THE National Consumer Commission is taking four medical schemes to the Equality Court for contravening provisions of the Consumer Protection Act.
Encouraged by regulators such as the Council for Medical Schemes and facing tough economic conditions, members of medical schemes are becoming increasingly militant. But the commission is taking on practices protected by law.
The commission is challenging "late joiner" penalty fees for people who join schemes after the age of 36 and waiting periods imposed before members get full benefits.
National Consumer Commissioner Mamodupi Mohlala-Mulaudzi said yesterday her organisation had lodged papers with the Equality Court on June 28.
The medical schemes taken to task are Fedhealth, Momentum, Medshield and Bonitas.
Ms Mohlala-Mulaudzi said schemes "want people to join at a young age. They use the late joiner fee to subsidise older members.
"Some people can't afford to join early . what about people who don't grow up in South Africa and come back as adults?"
She criticised the three-month and 12-month waiting periods, saying members should have access to benefits "from day one". The 12-month period discriminated against pregnant women.
"In terms of the Consumer Protection Act, when I pay I must get the service," she said. "The act states that if there is a transgression against consumers that affects their constitutional rights, we can refer the matter directly to the Equality Court."
Medshield acting executive principal officer Jonathan Phillips said his company would defend the court action, as it applied its rules according to the Medical Schemes Act. "The waiting period applies to condition-specific exclusions permitted as per the Medical Schemes Act. Late joiner penalty fees are applied specifically to discourage anti-selective behaviour as well as to protect the best interests of the overall membership," he said.
Damian McHugh, head of marketing at Momentum Health, said the company needed to establish whether the court action had been launched before commenting.
Dr Boshoff Steenekamp, acting registrar of the Council for Medical Schemes, also pointed to the legal framework.
"There is open enrolment which means medical schemes must accept you. Then there are prescribed benefits. If you get cover, they must pay for that.
"There is also community ranking which means everybody pays the same premium for the same benefit - unlike short-term insurers where you are judged on risk," Dr Steenekamp said.
However, this framework created opportunities for "anti-selection", he said. "People did not join schemes when they were young and healthy. But then, when I am older or diagnosed with cancer, I run to a medical scheme to claim benefits. That makes me a free rider because for all those years when I was young and healthy I did not contribute anything."
Heidi Kruger, head of corporate communications at the Board of Healthcare Funders, said although she understood "where the consumer commission came from", representations would be made to the Equality Court.
"Medical schemes are basically stokvels. People . who are about to give birth or . who are about to get a heart bypass should get this with a one-month premium, she (the commissioner) says.
"There is nothing stopping someone from leaving the scheme after that . but it would wipe out all the funds," Ms Kruger said.