Dear Member,
At Profmed, your health and well-being are at the heart of everything we do. We understand that recent news about the Constitutional Court’s judgement in the Steyn case may raise concerns, and we want to take a few moments to provide clarity and reassurance that Profmed continues to maintain the highest level of integrity and care for all our members.
The Constitutional Court’s decision marks the conclusion of an eight-year journey, and while we are committed to abiding by the ruling, we remain focused on our long-standing mission: protecting the healthcare needs of South African professionals. It was brought to our attention that after many years since Steyn had left Profmed that the member had since passed away and we would like to express our deepest sympathies to the Steyn family for their loss.
As a member-driven medical scheme, safeguarding the reserves that you and others have built over many years, is one of our top priorities. Part of this entails making sure all new members disclose any pre-existing health conditions upon joining Profmed. Where these are declared, a 12-month waiting period may be applied, which effectively excludes cover for the first year of membership. This ensures that members contribute to the reserves before claiming from them, a standard industry practice in line with the Medical Schemes Act.
In the case, Steyn was terminated due to Profmed believing there was non-disclosure of pre-existing conditions. The Appeal board at the Council for Medical Schemes and a full bench of the High Court agreed with Profmed. The total claims in the first 11 months of membership, amounted to approximately R400,000 while the member contributed less than 10% of that amount in premiums. Such claims use the reserves of long-standing members who have over many years not claimed more than their contributions.
Though we were surprised by the Constitutional Court ruling, we will continue to respect the decision related to this case and move forward in clarifying issues relating to new members disclosing pre-existing conditions. However, we have noted that the ruling doesn’t clarify the key concepts of material non-disclosure and further requires schemes to define this more specifically in the registered rules of the Scheme.
Profmed remains committed to ensuring fairness and sustainability for everyone and will continue to protect existing members reserves while taking care of new members. As always, we remain dedicated to ensuring our scheme operates in a way that benefits you – our valued members – by maintaining financial stability and access to quality healthcare.
We thank each of our more than 34 000 members of the Profmed family, for your trust and continued support as we work to protect your health, now and into the future.
Warm regards,
The Profmed Team
