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Can a main member of a medical aid be held liable for costs incurred by a non-member on behalf of a minor dependant?

Medical Aid Liability

In South Africa, a child of divorced parents is usually placed in the primary care of one parent while the other parent financially maintains the child. Due to this, the child may be on the medical aid of a financially responsible parent. As the child is in the care of the caregiving parent such parent would handle matters such as doctor’s or optometrist visits. However, this parent would not be paying for such services. This is all fine and well when the financially responsible parent has agreed to such services being elicited before the appointment and where such services are covered by the financially responsible parent’s medical aid. The problem occurs when the medical aid benefits are exhausted, or the services required are not covered by the medical aid. This article seeks to identify whether the financially responsible parent would still be liable where he/she is unaware of such expenses and the caregiving parent enters into an agreement but indicates that the financially accountable parent will carry the costs.

Where we deal with matters as a result of divorce there is always a court order of divorce. As such the financial duties of both parents in respect of the minor child are strictly outlined in the divorce order. Where the order indicates that the financially responsible parent (usually the father) is required to cover the medical expenses of the minor child and that such a child would become a member of this parent’s medical aid, it is quite clear that the child is covered financially in this respect.

A divorce order generally would indicate that serious medical issues should be discussed between the parents first before anything is entered into. The court order may also indicate that the father must provide for the medical expenses of the child outside of the costs provided for by the medical aid. However, it cannot be a blanket provision. The law always tries to find a balance between the rights and responsibilities of parties. As such the mother should not act as if she has a “blank check” concerning the medical expenses of the child. Where costs outside of that are covered by medical aid, the parents need to discuss the costs and the mother should only enter into agreements once the father’s consent has been obtained.

South African law at present does not have a strict provision to deal with such circumstances. The best manner in which to avoid such disputes is for the attorneys to draft the clauses of the divorce summons to provide for contingencies in such extenuating circumstances.

 

Should you be considering entering into divorce proceedings contact us and we will draft your divorce summons which provides for such extenuating circumstances.

 

Saeedah Salie
saeedah@bbplaw.attorney
Associate

 

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