; US PARTICIPATION POLICY MEDICAL SCHEME
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US PARTICIPATION POLICY MEDICAL SCHEME

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US PARTICIPATION POLICY MEDICAL SCHEME

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									US PARTICIPATION POLICY: MEDICAL SCHEME

1. INTRODUCTION 1.1 It is compulsory for all permanent employees, except for staff specified in paragraph 1.2, to become members, from the date of entering service, of the medical scheme approved by the University of Stellenbosch (US). 1.2 Compulsory participation in the scheme approved by the US is, however, not applicable to the following members: i. Staff in post levels 13 to 17

ii. Part-time permanent staff; and iii. Staff covered by their spouses’ medical scheme. 1.3 Membership of the Medical Scheme is subject to the Rules of the approved medical scheme. 2. DEFINITIONS OF TERMS 2.1 "Employee" Any person in a permanent capacity appointed on a full-time or part-time basis to assist the US in the course of carrying out his/her work. 2.2 "Pensioner Member" A principal member who has retired on pension from the service of the US. 2.3 “Spouse” i. A person who is legally recognised as being married;

ii. A person who lives with another person and intends permanently to remain living in that condition and who may reasonably be judged, in accordance with the facts of the particular case, to be accepted as a participant in a permanent relationship of cohabitation. 3. MEMBERSHIP OF THE MEDICAL SCHEME 3.1 Membership of employees

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3.1.1 In the event of an employee and his/her spouse both being employed by the US, both need not register as principals of the Medical Scheme. The family may decide which employee will be registered with the medical scheme as the principal member and which as the dependant of the principal member. 3.1.2 If an employee, who is a member of the medical scheme of the US, marries, he/she may choose to remain a member of the medical scheme of the US and to register his/her spouse and children with the medical scheme of the US or to accept membership of his/her spouse’s medical scheme. Documentary evidence of the last-mentioned option must be submitted to the US. Registration of dependants is subject to the rules of the medical scheme concerned. Should the member and his/her family decide to accept membership of the spouse’s medical scheme and then at a later stage voluntarily to rejoin the medical scheme of the US, the application shall be subject to individual endorsement by the medical scheme concerned. 3.1.3 Should both parents of a child (children) registered with the medical scheme die, the contributions by Council will continue to be paid until the child (children) reach the age of 21 years. medical scheme. 3.1.4 An increase or decrease of the member’s dependants must be reported to the US in writing, within the period stipulated by the medical scheme after such change, in order that the membership lists and medical contributions may be adjusted accordingly. 3.1.5 Should the member’s marital status and/or the number of dependants or status change, the remuneration package of the member will be kept at the same level while the elements of the package are changed so that the employee’s remuneration package may be restructured to provide for the new medical contribution. 3.2 Membership of pensioner members 3.2.1 Should an employee die while still in the service of the US or after that he or she has left the service of the US on pension, the employee’s/pensioner’s Should more than one child be registered, the oldest child will be registered as the principal member of the

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registered spouse and if not applicable, the oldest of the registered dependants, will be regarded as the principal member of the medical scheme. The principal member will in such cases qualify for the appropriate contribution by Council. Should a spouse who has become a principal member in this manner marry, the contribution of the Council with regard to the spouse will fall away. The contribution of the Council with regard to the registered dependants will in such cases be maintained. 3.2.2 Employees who are medically unfit will be treated as employees until their retirement on pension from the service of the US, after which time the rules applying to pensioner members will apply. 3.3 Membership of dependants 3.3.1 The registration of dependants is subject to the Rules of the Medical Scheme in this regard. 3.4 Cancellation of membership 3.4.1 Where the principal member cancels the membership of a dependant, the re-registration of the dependant concerned will take place in terms of the rules of the medical scheme. 3.4.2 Pensioner members who resign from the medical scheme of the US will not be able to re-register as members of the medical scheme of the US. 3.5 General conditions applying to membership of the Medical Scheme 3.5.1 A member or any of his/her dependants may not simultaneously be a member of the medical scheme of the US and of any other registered medical scheme or submit a claim for the same service to two medical schemes simultaneously. 3.5.2 Should a member die, the member’s dependant(s) who at the time of the member’s death is/are registered as dependant(s) will be offered the choice of remaining member(s) of the medical scheme (see paragraph 3.2.1 above).

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3.6 Determining the Council’s contributions to the medical scheme contributions after retirement 3.6.1 A principal member who was employed by the US before 1 September 1997, or who was appointed between 1 September 1997 and 31 May 2002 and who on retirement has 20 years of continuous service will, after retirement, receive for life the Council’s contribution with regard to himself/herself and his/her adult dependant. With regard to any other dependants, the rules of the medical scheme will determine the period of membership and consequently the period for which the Council’s contributions shall be payable (see also paragraph 3.6.5). 3.6.2 A principal member who was appointed between 1 September 1997 and 31 May 2002 and who on retirement has fewer than 20 years of continuous service, will receive the Council’s contribution only for the equivalent number of years of continuous service. The Council’s contribution with regard to him/her and his/her dependants will, after retirement, remain unchanged and consequently will not be adjusted in accordance with increases in contributions, inflation in medical costs or any other norm. 3.6.3 A principal member who entered the service of the US on 1 June 2002 or thereafter will not be entitled to any contributions by the Council toward the Medical Scheme. 3.6.4 If a principal member retires on pension from the service of the US before the age of 60, the Council’s contribution to the medical contributions will be decreased by 0,25% for each month of retirement before the age of 60. 3.6.5 The particular benchmark decided upon by the US Council as the basis for calculating its maximum contribution and the particular option of the medical scheme in which the principal member is participating at the time of retirement, as well as the number of his/her dependants, will determine the monthly contributions that the Council will make to the pensioner with regard to the medical scheme. 3.6.6 Should the number of dependants of a pensioner member decrease after retirement, the Council’s contribution to the medical contributions will be reduced accordingly.

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3.6.7 The Council’s contributions to the medical contributions after retirement will be coupled to the persons of the principal member and his/her dependants. Should a change in the marital status of the principal member after retirement result in an increase of his/her dependants, such additional dependants may be accepted by the medical scheme for membership, but will not qualify for any contributions by the Council to the member’s medical contributions. 3.6.8 Continued membership of children reaching the age of 21 will be determined by the rules of the medical scheme. 3.7 Determining the Council’s contributions to the medical scheme in the event of death while in employment 3.7.1 The adult dependant of a Principal member who was employed by the US before 1 September 1997 or who was appointed between 1 September 1997 and 31 May 2002 and who at the time of death has 20 years of continuous service, will receive the Council’s contributions for life. In the case of any additional dependants, the rules of the medical scheme will determine the period of membership and consequently the period for which the Council’s contributions will be payable (see also paragraph 3.6.5). 3.7.2 The dependants of a Principal member appointed between 1 September 1997 and 31 May 2002 and who at death has fewer than 20 years of continuous service, will, on the death of the Principal member, receive the Council’s contribution only for the period equivalent to the number of years of continuous service of the Principal member. The Council’s contribution will remain unchanged and consequently will not be adjusted in accordance with increases in contributions, inflation in medical costs or any other norm. 3.7.3 A principal member who entered the service of the US on 1 June 2002 or thereafter will not receive any contributions by the Council toward the Medical Scheme and consequently the dependants of such a Principal member will also not be entitled to any contributions by the Council. 4. COLLECTION AND PAYMENT OF CONTRIBUTIONS 4.1 The medical scheme contributions are paid by the US to the medical scheme.

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4.2 Any contribution by a pensioner due to the medical scheme must be paid by the pensioner to the US by means of a debit order or cheque, after which the US will pay the membership contributions to the medical scheme. 4.3 The onus will be on the pensioner member to inform the US of any changes of address or details of bank account.

November 2006

Deelnamebeleid Mediese Skema.doc/Personeelhandleiding/November 2003 MHB-Tuisblad


								
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