Benefits & Rules


Rules

Scheme Rules

 WCMAS Rules

Membership / Amendments of Medical Aid Records

Status of your registered dependants?

It is important that registrations or de-registration of dependants be reported at the time office/HR department at your earliest. All the relevant documentation e.g. birth certificates, marriage certificate, divorce papers, death certificate, proof of further tertiary study etc needs to be supplied to the time office/HR department who has to forward the information to the Scheme. Please follow up and ensure that the necessary amendments have been received and processed by WCMAS. Information about you and your dependants must be true, correct and complete at all times.

Newborn or newly adopted child

A member must register a new-born or newly adopted child within 30 days of the date of birth or adoption of the child. Increased contributions shall then be due as from the first day of the month following the birth or adoption and benefits will accrue as from the date of birth or adoption.
* Failure to register your new-born or newly adopted child timeously may result in waiting periods and condition specific exclusions being imposed.

Marriage

A member must apply within 30 days of the date of marriage to register his/her spouse as a dependant unless the spouse is registered on another medical aid. Increased contributions shall then be due as from the date of marriage and benefits will accrue as from the date of marriage.
* Failure to register your spouse timeously may result in waiting periods and condition specific exclusions being imposed.

Common-Law-Spouse / Traditional Marriage

A member may apply to have his/her partner registered as a dependant and must produce satisfactory proof to the Board of Trustees of the committed relationship and mutual dependency. You will also be required to provide a doctor's certificate stating the dependants current state of health together with a membership certificate of a previous medical aid.
* Waiting periods and condition specific conditions may be applied.

*General and Condition Specific Waiting Periods

Members are reminded that as per the Scheme Rules, general waiting periods and pre-existing condition exclusions may be applied to new dependants registered who were not a member of a medical aid previously, except for new-born babies and marriages.

Students over 21

A member may apply for continuation of membership for his/her child who is over the age of 21 but is not yet 26 years of age, who is a full-time student at a tertiary-, training- or education institution constituted in terms of the South African Qualifications Authority Act. Please note that proof of university or college enrolment must be provided annually in order for these dependants to receive benefits. Applications must be renewed annually at the beginning of each year for as long as the student studies. Should proof of enrolments not reach us timeously, the dependant's membership could be cancelled.

Resignations

A member who resigns from the service of an employer shall on the date of such termination cease to be a member and all rights to benefits shall therefore cease except for claims in respect of services rendered up until the resignation date.

Divorce

All members are advised that in terms of the WCMAS Scheme Rules, a member must de-register his/her spouse should they divorce. Even if the settlement agreement stipulates that the member must provide medical aid cover for his ex-spouse, they may not remain a dependant of the member. The member must then ensure that they take out alternative medical aid cover for their ex-spouse. Failure to comply with this Rule will be viewed as defrauding the Scheme.

 
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