Application contribution & eligibility audit
A line-by-line review of the proposed membership, contribution basis and eligibility evidence, ending in a prioritised findings report.
Request this audit
Who this review is for
This is the broadest file review for an applicant, employer benefits team or accredited adviser who needs to know whether an application is internally consistent before submission, or why a submitted file has drawn a scheme query. It is particularly useful where income, employer subsidy, dependant status or prior membership affects the contribution or acceptance route.
What we examine
We reconcile the application form against the documents supplied for the agreed scope. That can include the chosen plan and membership category, principal member and dependant relationships, stated commencement date, income band, employer contribution, applicant share, prior cover and evidence relevant to general or condition-specific waiting periods.
The audit includes:
- a completeness check against the scheme’s stated application requirements;
- an independent recalculation of the expected contribution;
- a review of membership and dependant eligibility evidence;
- a consistency check across dates, names and declarations;
- a schedule distinguishing errors, missing evidence and matters requiring scheme confirmation; and
- a 30-minute findings call.
We do not decide whether a scheme must accept an applicant, provide legal representation, give clinical advice, alter records or submit the application on your behalf. Final underwriting and membership decisions remain with the registered medical scheme.
How the engagement runs
1. Scope and secure transfer
After a short call, we confirm which application, scheme rules and calculation period are in scope. If the review proceeds, we provide instructions for an appropriate document-transfer method. Please redact clinical detail that is not relevant to the agreed question.
2. Reconciliation
A reviewer maps the people, dates, plan option, income basis and contribution split across the file. We record source documents and flag where two records make different claims.
3. Findings and route forward
Within three to five business days of receiving a complete file, you receive a PDF findings schedule. High-priority items appear first, each with the evidence relied on, the likely consequence and a suggested next action. We then talk through the report.
Preparing the file
Have the latest application form, contribution table, relevant payslip or employer schedule, proof of relationship where applicable, and scheme correspondence available. Do not send identity numbers or health information through the website enquiry form. We will tell you what is needed after scope confirmation.
Fee and constraints
The fee starts at R4,800 including VAT for one application covering a principal member and up to three dependants. We quote first where there are more dependants, multiple contribution periods, conflicting payroll records or a file exceeding 80 pages. A 50% deposit reserves review time; the balance is due before release of the findings report.