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Affinity Enterprises: Honesty is the healthiest policy when it comes to medical aid

Affinity Enterprises: Honesty is the healthiest policy when it comes to medical aid

Honesty is the healthiest policy when joining a medical aid scheme, says Affinity Enterprises. Full disclosure of any health issues is vital in building and maintaining a transparent relationship with your medical aid provider and ensuring that you are adequately covered in the event of a claim.

Medical aid insurance is an amazing product that is there for you and your loved ones when you need it the most. It’s important, however, that you take all the necessary steps needed so make sure you’ve done everything you can to get the best possible coverage. When joining a medical aid scheme, you’ll be asked questions about your medical history and your current health status. This is called “underwriting” and medical schemes use it to work out the right coverage for your individual needs,” says Murray Hewlett, CEO of Affinity Enterprises.

“Some questions you may be asked include your age, gender, height, weight, lifestyle, and medical history. Hypothetically, let’s say you’re a social smoker. So, when you reach the question about how frequently you smoke, you may think it’s not worth raising a red flag over a few cigarettes every other day. Or maybe you have a family history of a disease or illness, but it only pertains to your grandparents, so you don’t disclose it. “

No big deal, right? Wrong, says Hewlett. Omissions can affect you years down the line when you put in a claim. That’s because medical schemes do background checks on the information you disclosed in the initial underwriting. Anything that’s in your doctors’ files may become known. No matter how long ago the healthcare issue may have occurred, or how insignificant you think it is, rather play it safe and disclose all the information you can.

Medical cover – just like vehicle cover or life cover – is not a sale transaction where the purchaser receives the goods or services for which he/she has paid.  Rather, it is an insurance transaction where there are conditions attached to a scheme’s responsibilities under the insurance contract.  If a member breaches those conditions, the scheme’s obligation is not triggered.

“Your claim might not be paid – or not paid fully – even if your claim has absolutely nothing to do with the illness or condition you failed to disclose. All those premiums you paid years before will be wasted and, more importantly, you won’t have the financial support you had anticipated at a time when you (or your family) so desperately need it. You may also find yourself suspended from your coverage. Once you have been suspended from one medical scheme, it may be difficult to join another one,” continues Hewlett.

Be honest.  Even the smallest act of dishonesty, whether intentional or not, can have consequences for patients, their families and their doctors. If you are unsure about any questions that your medical scheme asks, then rather err on the side of caution and ask for clarification. That way, you will never have to worry about the medical scheme not paying out if you make a claim. 

About Affinity Enterprises

Affinity Enterprises Holdings is a diverse and proudly South African financial services group operating nationwide from Gauteng. Affinity Enterprises believes in holistic development. The success of the Affinity suite of insurance products comes off the back of identifying operational and client-facing gaps in the insurance market. By repositioning and repackaging our products we have been able to sustain the growth of 100% year-on-year.

Affinity Enterprises parents subsidiary companies that specialise in financial, healthcare and insurance-related services. One of which includes Affinity Health, which aims to provide premier quality, affordable medical insurance to South Africans, and strives to give clients peace of mind and the highest standard of service when they are faced with injury or illness. 

Since the establishment of Affinity Health in 2011, Affinity Enterprises Holdings has been nurturing optimal value for its stakeholders, aligning our business objectives with a client-centric approach to product design and service delivery.  The South African insurance market is highly competitive, driving innovation and value for consumers – a hallmark of this being market-changing product development; this is where Affinity Enterprises has excelled. Our Core Divisions include Health Insurance; Dental Insurance; Funeral Cover; Emergency Medical Services; and Integrated Emergency Response. Follow us on Facebook, or log onto our website.