The Small Print

Medical aid is not a one-size-fits-all situation and you need to seriously consider your medical needs and affordability before choosing the right health care plan. That said, choosing the right plan can be overwhelming. While the concept of medical aid is basic – you make a monthly contribution and receive medical cover – it is not without it’s head-scratching regulatory criteria and jargon. It is easy to feel frustrated and confused.

Choosing a medical aid plan without understanding its regulations and terms and conditions means you could end up completely derailing your plans and expectations and even depleting your savings. Here are some things you need to know before joining a medical aid.

Can I add dependents?

As a primary member, you can add all your true dependants to your medical aid scheme, including your spouse, biological and adopted children. You must identify the needs of each member before choosing the right medical aid plan. Many medical aid providers will allow you to add extended family members, for example, your parents, grandparents or siblings, but you may need to produce proof of wither legal guardianship or that they are financially dependant on you.

Switching plans

Most medical aid schemes allow members to either upgrade or downgrade plans, although, depending on the scheme or provider, this may only be done at certain times of the year. If you fail to make any required changes during this window, you will only be allowed to switch plans during the next window, which will typically be the following year. Please read the terms and conditions of your scheme carefully to find out your options.

Waiting period

Medical aid companies are legally obligated to accept anyone who applies for membership, but not without its conditions. People who or older, sickly or have pre-diagnosed conditions are considered riskier member and will have to endure a compulsory waiting period. This can be seen as a probation or trial period where you make your monthly contributions for a specified period but are only entitles to the full benefits of your medical insurance once this period ends.

There are typically two types of waiting periods – a general waiting period of three months and a 12-month waiting period for persons with a pre-existing condition. This waiting period is general and may vary by provider.

Late joiner penalty

Older members are considered riskier; therefore, medical aid providers impose a late joiner fee for new members joining the scheme later in their lives. This fee typically applies to new members aged 35 or older and were not members of a medical aid scheme before. This fee is added to your monthly contributions, does not expire and is a percentage of your total monthly contribution, with the exact percentage based on how long you previously remained uncovered.

Cancelling medical aid

Many medical aid schemes allow you to cancel at any time, provided you give them at least one month’s notice. Once you cancel, your benefits will end the last day of the 30-day notice period. If you have a savings plan, you will be paid out the remainder of the funds.