Medical Aid Schemes and the RAF

In terms of the rules of most medical aid schemes, any member who institutes a third party claim and recovers medical expenses from the RAF that have already been covered by the medical aid scheme, should reimburse the medical aid scheme. This is based on a contractual agreement between the member and the medical aid scheme. In terms of the rules of most medical aid schemes, medical aid schemes are not liable for any accident-related costs in cases where the member can institute an action against another party. In other words, medical aid schemes do not have to pay for any medical expenses arising from an accident for the recovery of such costs. If they do pay however, they do so in the form of a loan to the member. If medical aid schemes did not do this, members would be refused treatment in private institutions and referred to state-run hospitals. Alternatively, the member would have to pay his medical bills out of his own pocket. Most medical aid schemes do not charge interest on such advances to their members. Borrowing from the medical aid scheme therefore holds an interest benefit for the member who would have had to borrow the money elsewhere to receive quality treatment.

Another advantage is that medical aid benefits are reinstated upon reimbursement of the scheme.

For the reasons set out above, our clients are often required to give undertakings to their medical aid schemes that any medical expenses recovered from the RAF will be paid over to the medical aid, upon successful finalisation of the third party claim.