If you are divorced and wondering how it will affect your medical aid then it is best that you contact your medical aid broker or medical scheme as soon as possible. Many South African main members are unaware that they cannot keep their ex on their medical aid unless a court agreement says so. The situation may be judged on an individual basis if the main member appeals it and wishes to keep their ex on their medical aid. However, there is no guarantee that the scheme will consider the request.
Cover for Ex-Spouse Adult Dependants
Your medical aid only recognises the main member’s financial dependants with whom they have a legitimate relationship as being valid dependants on the plan. This means that you and your children are allowed to be covered on the same plan after a divorce if you are the main member. Biological children are automatically accepted while adopted children will only be accepted with the proper paperwork verifying the adoption.
Any other person, be it a sibling, parent or grandparent, has to be proven to be your financial dependant meaning that they cannot work and that you are supporting them. Generally you cannot add any other person or people to your plan – be it an uncle/aunt, nephew/niece or friend. The exception lies with children that you have legally adopted. Once your divorce is finalised, then the nature and legality of your relationship with your spouse (now ex-spouse) has changed.
If your ex-spouse is dependent on your for financial support and a court agreement exists after a divorce, then the scheme may retain your ex husband or ex wife on the same plan as an adult dependant. Otherwise your ex spouse is now responsible for himself/herself and has to take on their own medical aid, or join a plan where their relationship to the main member is recognised.
Keeping Spouse Covered After Divorce
The moment a scheme is notified of the divorce, your ex-spouse is no longer eligible to be an adult dependant unless you can provide a documentation to state otherwise. The onus is on the main member to clarify the change in relationship with the medical scheme. There are some mitigating circumstances especially with the complexities of relationships that exists these days, like a live-in partner and so on.
However, these individual cases need to be clarified with your medical aid directly. Most schemes do not penalise the main member for failing to notify them about a divorce. However, you ex-spouse’s bills will not be paid and could even be reversed from the service provider (doctor, hospital and other health care providers) from the date the divorce was legally in effect.
Trying to sign up your ex-spouse with your previous marriage certificate (that is no longer valid due to the divorce) is seen as non-disclosure and schemes can terminate membership. Whatever the case, it is important that you are straightforward and honest with your medical aid at all times. Trying to bypass policies by hiding facts can jeopardise your membership and that of the other dependants on your plan.
Ultimately this means that you will be facing medical bills that your scheme refuses to pay. Remember that your scheme is always looking at an amicable solution so rather speak to them as soon as possible if you have erred.