Concession Business: January 2025

 

Below is information about the concession business for the January 2025 take-on.

The Medical Schemes Act permits employer groups to transition between medical schemes on January 1st of each year without incurring any waiting periods. This process is commonly referred to as Concession Business, providing a unique opportunity for employers to optimize their medical scheme options for their employees.

The following criteria must be adhered to for all applications pertaining to the 2025 Concession Business:

• The employer group must establish its date of commencement as January 1, 2025. This ensures that all transitions are synchronized with the start of the new year, allowing for a seamless integration into the new medical scheme.
• There must be a legitimate employer/employee relationship in place. This criterion is essential to validate the employer group’s eligibility and ensures that the medical scheme is being utilized for its intended purpose.
• Employer groups are required to have a minimum of two employees. This stipulation is in place to foster a collective participation in the medical scheme, thus enhancing the risk pool and ensuring sustainability.
• Self-employed individuals do not qualify for the underwriting concession. This exclusion is designed to maintain the integrity of the group scheme, which is fundamentally based on an employer-employee dynamic.
• Billing and contribution collection will be conducted exclusively in advance, utilizing debit orders as the only accepted method. This approach streamlines the payment process and ensures that contributions are received in a timely manner.
• It is mandatory for all staff currently enrolled in an existing medical scheme to transfer their membership to the Momentum Medical Scheme. This requirement ensures that all employees are covered under the same scheme, promoting uniformity and cohesion within the employer group.
• Employees who are not currently beneficiaries of an existing medical scheme will be subject to full underwriting. This means that their health status will be assessed in detail to determine eligibility and coverage options.
• Late joiner penalties may be applied where applicable. This serves as a deterrent for delays in joining the medical scheme and encourages timely enrollment.
• The remaining periods of any existing waiting periods or exclusions will be enforced. This means that if employees have previously been subject to waiting periods or exclusions, those will carry over to their new membership with the Momentum Medical Scheme.

Requirements

In order to proceed with the application process, please ensure that the following documents are submitted through your Business/Practice Consultant or Momentum Medical Scheme Specialist by September 30, 2024:

• A letter of intent indicating the desire to join the Momentum Medical Scheme effective January 1, 2025. This letter serves as a formal request and outlines the employer group's commitment to the transition.
• A fully completed company application form. This form collects essential information about the employer group and facilitates the processing of the application.
• The payroll records for the previous three months. If the employer does not possess direct proof of payroll, alternative documentation such as submissions made to SARS, proof of UIF payments for each employee, or a letter from the auditor confirming a list of employees will be accepted.
• An electronic submission of the group's demographics in an MS Excel spreadsheet. This spreadsheet should include the following details:
  • Full names, dates of birth, and gender of the principal member.
  • Information on spouse, adult, and child dependants.
  • An indication of any chronic conditions among the members.
  • Income details of the employees.

Provided that all criteria are satisfied and the necessary documentation is submitted on time, terms of acceptance will be communicated by October 31, 2024.

Once the terms of acceptance are received, they must be signed by the employer and returned along with the following documentation by November 29, 2024:

• Fully completed individual member application forms for each employee.
• Certificates of existing medical scheme membership for every employee. This documentation is crucial to ensure continuity of coverage and to facilitate the transition process.

For groups that fulfill the standard group underwriting criteria, submissions should be made through the regular New Business channels. Should you require any additional information regarding Concession Business, please do not hesitate to reach out to your Business/Practice Consultant or the Momentum Medical Scheme Specialist, who will be more than happy to assist you.