Who can be a dependant on my medical scheme?

As a member of a medical scheme, you are entitled to register your dependants on the scheme.

The Medical Schemes Act provides for the following dependants to be registered on a medical scheme:

• Your spouse or life partner;
  
  
• Your dependent children;
  
  
• Any other immediate family members for whom you are liable for family care and support; and
  
  
• Any other person recognised as a dependant under the rules of your medical scheme.

The Council for Medical Schemes published a set of guideline model rules for medical schemes. In the model rules, the council suggests that schemes include a definition of immediate family member as:

• A member’s spouse or life partner;
  
  
• A member's dependent children;
  
  
• A member's legally adopted children; or
  
  
• In the absence of a spouse, life partner or dependent children, the member’s siblings and parents for whom the member is liable for family care and support.

As the model rules are not regulated, schemes can have their own definitions of immediate family that may include, for example, grandchildren or grandparents.

The 2018 Medical Schemes Amendment bill proposed an amendment to the definition of a dependant to include:

• Dependent grandchildren;
  
  
• Any other relative of the member:
  
  
  • To whom the member has a legal duty to provide family care and life maintenance or income support; and
  • To whom the member in fact provides care, maintenance or support.

This amendment was not tabled in parliament. However, it should be noted that the intention was to ensure that schemes include as dependants:

• A former spouse if a divorce order makes you liable for your ex-spouse’s medical scheme contributions;
  
  
• Stepchildren and foster children; or
  
  
• Your parents or siblings.

Contributions

Registering dependants on your membership rather than signing them up in their own names can save you in contributions as typically schemes set child contribution rates much lower than the main member’s contribution rate and adult dependant rates are slightly discounted relative to contributions for the main member.

Schemes will allow you to pay child dependant rates at least until age 21 if your children are still financially dependent on you. Schemes have different rules after children reach the age of 21 – some will allow you to keep them on as child dependants if they are fulltime students up to the age of 25 or 27. Other schemes regard them as adult dependants even if they are full time students and financially dependent on you.

If a child is physically or mentally disabled, they can remain on your scheme as an adult dependant but you may need to provide proof of dependency.

Other immediate family members may include your parents, parents-in-law or siblings. You may also be allowed to register other family members such as a niece, nephew or grandchild but you may need to prove that you are supporting them financially with at least 50 percent of their living expenses.

Exclusions on cover

An application to register a dependant on your scheme cannot be declined if the dependant meets the definition in terms of the Act or the rules of the scheme.

A waiting period and late-joiner penalty can, however, apply to dependants. So, for example, a member registering parents as dependants when parents have never had cover or have not been members or dependants for years, could be charged late-joiner penalties on the parents’ contributions. Waiting periods – general or condition specific - may also apply if there has been a break in membership.