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Dad’s battle with medical aid scheme isn’t over yet

THE little girl is doing well after her difficult birth. Born at just 27 weeks and weighing a mere 1,85kg, she required urgent medical attention. But Athénaïs pulled through and is now 17 months old and learning to take her first steps. She’s the apple of her parent's eye and watching her grow is their greatest joy.

However, there are still outstanding medical bills related to her treatment because of an ongoing battle her father, Jens Herf, is waging with his medical aid, Genesis.

Athénaïs was born in Cape Town after her mom, Aude Geoffroy, went into premature labour. The baby needed to be in an incubator and was also diagnosed with anemia. Jens applied for the baby to be admitted as a dependant on his medical aid within 30 days of her birth.

However, the scheme told him a three-month waiting period applied, as well as a 12-month condition-specific waiting period for conditions related to low birth weight or complications arising from premature birth.

In a previous article (YOU, 11 March), Jens (44), a tech specialist and web designer, told how he took the matter to the Council for Medical Schemes (CMS), questioning the legality of the waiting periods and seeking payment for the baby’s outstanding bills.

The CMS ruled in Jens’ favor, saying Genesis’ decision to impose waiting periods was without a legal basis.

It said the decision was in contravention of a section of the Medical Schemes Act (MSA), which states that “a medical scheme may not impose a general or condition-specific waiting period on a child dependant born during the period of membership”.