Genesis Medical Scheme
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MR
Mari R
1 reviews | Active since Member
22 Jul 2025, 19:51
Disappointing and inhumane
Joining Genesis was the biggest mistake of my life. They made countless promises but showed zero compassion when it mattered most.
My one-year-old was hospitalised and placed on oxygen with RSV—an obvious emergency. Yet Genesis refused to cover the emergency claims. I asked multiple times why certain claims were rejected and received only contradictory answers. I eventually filed a complaint.
Around the same time, a non-disclosure investigation was opened. I provided full explanations, which Genesis accepted. They confirmed in writing that I remained covered. I understood they had the right to cancel my membership, and had they done so then, I would have accepted it. But they ruled in my favour, and I trusted their word.
A week after my complaint about the emergency claim, they suddenly reopened the non-disclosure issue—clearly in retaliation. They claimed I hadn’t provided reasons after I asked what they mean because they already asked regarding the same case and ruled in my favour, previously confirming the matter was finalised. My membership was cancelled, and I was told I couldn’t dispute it as I was no longer a member.
I take responsibility for the initial mistake in non-disclosure, but changing their decision after a complaint is *********. They had all the facts the first time and made a clear, unconditional ruling. Only after I questioned their emergency cover did they reverse it. No one even had the decency to speak to me and explain anything to me, no humanity - just long letters throwing acts and irrelevant cases in my face.
Sadly, I now see many similar complaints—emergencies not covered, cold responses, and no accountability. Genesis shows no humanity when people need it most. The non-disclosure was never my issue - the ruling in my favour and then going back on their words because of a service complaint is.
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Mari R's updateReviewer Update
22 Jul 2025, 20:21a few weeks ago I still recommended them everywhere, they were great until I experienced an emergency and really re**** on them. Now they left me, a single mother, under severe stress - with this additional burden and financial stress . I don't know a lot about these things and policies and acts but in the last month I was forced to read up and research just to be able to answer to their letters, and even then it wasn't enough. I don't understand how they can close a case stating 'I elected to not provide reasons' if they already had and accepted the Reasons a week prior. Now they state I don't acknowledge that it was material non-disclosure as I didn't give them an opportunity to impose waiting period - but a week before they ruled in my favour - the facts didn't change, there wasn't more things that wasn't disclosed, it was just the facts that they had full knowledge of when they ruled in my favor. So how can it now suddenly be material? Also how can I, someone not in the medical field or experience with any of this, compete with a fund trying to answer their long letters?
MR
Mari R's update22 Jul 2025, 20:21
Reviewer Update
a few weeks ago I still recommended them everywhere, they were great until I experienced an emergency and really re**** on them. Now they left me, a single mother, under severe stress - with this additional burden and financial stress . I don't know a lot about these things and policies and acts but in the last month I was forced to read up and research just to be able to answer to their letters, and even then it wasn't enough. I don't understand how they can close a case stating 'I elected to not provide reasons' if they already had and accepted the Reasons a week prior. Now they state I don't acknowledge that it was material non-disclosure as I didn't give them an opportunity to impose waiting period - but a week before they ruled in my favour - the facts didn't change, there wasn't more things that wasn't disclosed, it was just the facts that they had full knowledge of when they ruled in my favor. So how can it now suddenly be material? Also how can I, someone not in the medical field or experience with any of this, compete with a fund trying to answer their long letters?
Genesis Medical Scheme's replyOfficial
23 Jul 2025, 08:19Dear Mrs Renney
The information provided in your review appears be somewhat economical and selective with the truth and the facts.
A fundamental fact that also cannot be overlooked is the matter of non-disclose. In other words - did you make a full and honest disclosure of all your health conditions when you applied for membership of the scheme, or was material information withheld from the scheme that deprived it of its legal right to apply waiting periods on pre-existing conditions?
Unfortunately, every action has a reaction. In the medical schemes industry, every wrong-doing has a price tag attached to it and irrespective who is to blame, members of medical schemes ultimately pay the price for non-disclosure in the form of increased contributions.
Member fraud often occurs in the misrepresentation of medical information – a practice referred to as non-declaration of information (“non-dec”). This form of deception, whether intentional or not, is sharply on the increase.
According to Board of Healthcare Funders of SA (BHF), as well as the Council for Medical Schemes (CMS), up to 25% of the money paid as medical scheme contributions annually, is lost through fraud, corruption and abuse. The cumulative cost burden of fraud, abuse and waste is estimated between R22 billion and R28 billion a year.
Not only do medical schemes have the right in terms of the Medical Schemes Act to cancel a membership on the grounds of non-disclosure of material information, but members may also be found guilty of an offense and liable on conviction to a fine, or to imprisonment.
New applicants are always required to disclose their current and previous medical history in terms of conditions and / or treatment received. From this information the medical scheme will then assess your risk profile and may impose certain general and / or condition specific waiting periods, or late joiner penalties. This is done to protect the current members of a scheme from new members who may purely join a scheme to claim for a certain event – for example, if they need an operation, and then leave the scheme again before they have made any meaningful contributions to the risk pool of the scheme (an act referred to as anti-selection). Anti-selection prejudices other members who are contributing to the scheme on an ongoing basis and then have to carry the cost of those members who anti-select.
The trustees of medical schemes have a responsibility to the membership of the scheme as a whole, particularly those members who fully declared details of pre-existing conditions when joining the scheme and who were subject to the schemes’ normal underwriting criteria.
Medical schemes are creatures of statue and we may not operate outside the provisions of the Medical Schemes Act. Therefore, it is often very difficult for the employees of a medical scheme to “show compassion” (as you refer to it) when a member is in breach of the law, as no amount of compassion can reverse an intentional act of wrong-doing. Turning a blind eye to scenarios similar to this will be grossly unfair to the other members of a medical scheme. Honesty is always the best policy. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for patients, their families and their doctors.
Yours sincerely
GENESIS MEDICAL SCHEME
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-1/ https://www.genesismedical.co.za/non-disclosure-no-innocent-fraud/
The information provided in your review appears be somewhat economical and selective with the truth and the facts.
A fundamental fact that also cannot be overlooked is the matter of non-disclose. In other words - did you make a full and honest disclosure of all your health conditions when you applied for membership of the scheme, or was material information withheld from the scheme that deprived it of its legal right to apply waiting periods on pre-existing conditions?
Unfortunately, every action has a reaction. In the medical schemes industry, every wrong-doing has a price tag attached to it and irrespective who is to blame, members of medical schemes ultimately pay the price for non-disclosure in the form of increased contributions.
Member fraud often occurs in the misrepresentation of medical information – a practice referred to as non-declaration of information (“non-dec”). This form of deception, whether intentional or not, is sharply on the increase.
According to Board of Healthcare Funders of SA (BHF), as well as the Council for Medical Schemes (CMS), up to 25% of the money paid as medical scheme contributions annually, is lost through fraud, corruption and abuse. The cumulative cost burden of fraud, abuse and waste is estimated between R22 billion and R28 billion a year.
Not only do medical schemes have the right in terms of the Medical Schemes Act to cancel a membership on the grounds of non-disclosure of material information, but members may also be found guilty of an offense and liable on conviction to a fine, or to imprisonment.
New applicants are always required to disclose their current and previous medical history in terms of conditions and / or treatment received. From this information the medical scheme will then assess your risk profile and may impose certain general and / or condition specific waiting periods, or late joiner penalties. This is done to protect the current members of a scheme from new members who may purely join a scheme to claim for a certain event – for example, if they need an operation, and then leave the scheme again before they have made any meaningful contributions to the risk pool of the scheme (an act referred to as anti-selection). Anti-selection prejudices other members who are contributing to the scheme on an ongoing basis and then have to carry the cost of those members who anti-select.
The trustees of medical schemes have a responsibility to the membership of the scheme as a whole, particularly those members who fully declared details of pre-existing conditions when joining the scheme and who were subject to the schemes’ normal underwriting criteria.
Medical schemes are creatures of statue and we may not operate outside the provisions of the Medical Schemes Act. Therefore, it is often very difficult for the employees of a medical scheme to “show compassion” (as you refer to it) when a member is in breach of the law, as no amount of compassion can reverse an intentional act of wrong-doing. Turning a blind eye to scenarios similar to this will be grossly unfair to the other members of a medical scheme. Honesty is always the best policy. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for patients, their families and their doctors.
Yours sincerely
GENESIS MEDICAL SCHEME
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-1/ https://www.genesismedical.co.za/non-disclosure-no-innocent-fraud/
Best regards,
Genesis Medical Scheme's reply23 Jul 2025, 08:19
Official
Dear Mrs Renney
The information provided in your review appears be somewhat economical and selective with the truth and the facts.
A fundamental fact that also cannot be overlooked is the matter of non-disclose. In other words - did you make a full and honest disclosure of all your health conditions when you applied for membership of the scheme, or was material information withheld from the scheme that deprived it of its legal right to apply waiting periods on pre-existing conditions?
Unfortunately, every action has a reaction. In the medical schemes industry, every wrong-doing has a price tag attached to it and irrespective who is to blame, members of medical schemes ultimately pay the price for non-disclosure in the form of increased contributions.
Member fraud often occurs in the misrepresentation of medical information – a practice referred to as non-declaration of information (“non-dec”). This form of deception, whether intentional or not, is sharply on the increase.
According to Board of Healthcare Funders of SA (BHF), as well as the Council for Medical Schemes (CMS), up to 25% of the money paid as medical scheme contributions annually, is lost through fraud, corruption and abuse. The cumulative cost burden of fraud, abuse and waste is estimated between R22 billion and R28 billion a year.
Not only do medical schemes have the right in terms of the Medical Schemes Act to cancel a membership on the grounds of non-disclosure of material information, but members may also be found guilty of an offense and liable on conviction to a fine, or to imprisonment.
New applicants are always required to disclose their current and previous medical history in terms of conditions and / or treatment received. From this information the medical scheme will then assess your risk profile and may impose certain general and / or condition specific waiting periods, or late joiner penalties. This is done to protect the current members of a scheme from new members who may purely join a scheme to claim for a certain event – for example, if they need an operation, and then leave the scheme again before they have made any meaningful contributions to the risk pool of the scheme (an act referred to as anti-selection). Anti-selection prejudices other members who are contributing to the scheme on an ongoing basis and then have to carry the cost of those members who anti-select.
The trustees of medical schemes have a responsibility to the membership of the scheme as a whole, particularly those members who fully declared details of pre-existing conditions when joining the scheme and who were subject to the schemes’ normal underwriting criteria.
Medical schemes are creatures of statue and we may not operate outside the provisions of the Medical Schemes Act. Therefore, it is often very difficult for the employees of a medical scheme to “show compassion” (as you refer to it) when a member is in breach of the law, as no amount of compassion can reverse an intentional act of wrong-doing. Turning a blind eye to scenarios similar to this will be grossly unfair to the other members of a medical scheme. Honesty is always the best policy. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for patients, their families and their doctors.
Yours sincerely
GENESIS MEDICAL SCHEME
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-1/ https://www.genesismedical.co.za/non-disclosure-no-innocent-fraud/
The information provided in your review appears be somewhat economical and selective with the truth and the facts.
A fundamental fact that also cannot be overlooked is the matter of non-disclose. In other words - did you make a full and honest disclosure of all your health conditions when you applied for membership of the scheme, or was material information withheld from the scheme that deprived it of its legal right to apply waiting periods on pre-existing conditions?
Unfortunately, every action has a reaction. In the medical schemes industry, every wrong-doing has a price tag attached to it and irrespective who is to blame, members of medical schemes ultimately pay the price for non-disclosure in the form of increased contributions.
Member fraud often occurs in the misrepresentation of medical information – a practice referred to as non-declaration of information (“non-dec”). This form of deception, whether intentional or not, is sharply on the increase.
According to Board of Healthcare Funders of SA (BHF), as well as the Council for Medical Schemes (CMS), up to 25% of the money paid as medical scheme contributions annually, is lost through fraud, corruption and abuse. The cumulative cost burden of fraud, abuse and waste is estimated between R22 billion and R28 billion a year.
Not only do medical schemes have the right in terms of the Medical Schemes Act to cancel a membership on the grounds of non-disclosure of material information, but members may also be found guilty of an offense and liable on conviction to a fine, or to imprisonment.
New applicants are always required to disclose their current and previous medical history in terms of conditions and / or treatment received. From this information the medical scheme will then assess your risk profile and may impose certain general and / or condition specific waiting periods, or late joiner penalties. This is done to protect the current members of a scheme from new members who may purely join a scheme to claim for a certain event – for example, if they need an operation, and then leave the scheme again before they have made any meaningful contributions to the risk pool of the scheme (an act referred to as anti-selection). Anti-selection prejudices other members who are contributing to the scheme on an ongoing basis and then have to carry the cost of those members who anti-select.
The trustees of medical schemes have a responsibility to the membership of the scheme as a whole, particularly those members who fully declared details of pre-existing conditions when joining the scheme and who were subject to the schemes’ normal underwriting criteria.
Medical schemes are creatures of statue and we may not operate outside the provisions of the Medical Schemes Act. Therefore, it is often very difficult for the employees of a medical scheme to “show compassion” (as you refer to it) when a member is in breach of the law, as no amount of compassion can reverse an intentional act of wrong-doing. Turning a blind eye to scenarios similar to this will be grossly unfair to the other members of a medical scheme. Honesty is always the best policy. Even the smallest act of dishonesty, whether intentional or not, can have devastating consequences for patients, their families and their doctors.
Yours sincerely
GENESIS MEDICAL SCHEME
https://www.genesismedical.co.za/medical-scheme-non-disclosure-a-risk-never-worth-taking-part-1/ https://www.genesismedical.co.za/non-disclosure-no-innocent-fraud/
Best regards,
MR
Mari R's updateReviewer Update
23 Jul 2025, 09:05You were fully aware of the non-disclosure when you emailed me that you had ruled in my favour on the 3rd of July. While I agree and understand all of the above, going back on your word is the issue. No number of links or long emails can justify that. I took full accountability for the non-disclosure and never denied my fault in it. You confirmed in writing that my membership remains active and in place and that my reasons are thus accepted - there were no conditions attached to it - the case was closed... and a week later to retaliate, you opened the same non-disclosure that you finalised. So yes, you had the right to cancel the medical aid when the case was opened the first time... you did not have the right to give me a false, dishonest, favourable outcome... just to go back on your word a week later. I never overlooked the importance of non-disclosure. I took accountability where I was in the wrong. You should try it too.
MR
Mari R's update23 Jul 2025, 09:05
Reviewer Update
You were fully aware of the non-disclosure when you emailed me that you had ruled in my favour on the 3rd of July. While I agree and understand all of the above, going back on your word is the issue. No number of links or long emails can justify that. I took full accountability for the non-disclosure and never denied my fault in it. You confirmed in writing that my membership remains active and in place and that my reasons are thus accepted - there were no conditions attached to it - the case was closed... and a week later to retaliate, you opened the same non-disclosure that you finalised. So yes, you had the right to cancel the medical aid when the case was opened the first time... you did not have the right to give me a false, dishonest, favourable outcome... just to go back on your word a week later. I never overlooked the importance of non-disclosure. I took accountability where I was in the wrong. You should try it too.