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What you need to know about changing medical aids in South Africa

What you need to know about switching from one Medical Aid to another

It is once again that time of year when people begin to consider changing medical aids and often, there are several questions that first need answering.

Changing Medical Aid in South Africa

Since all the rules and regulations which govern the medical aid industry have become stricter over the years, it is crucial to know what you are getting yourself into when changing medical aids.

These rules and regulations may become increasingly frustrating for members; however, they have been put in place in order to protect both the members as well as the schemes themselves.

Doing an in-depth medical aid comparison can be hugely beneficial in ensuring that you understand each scheme’s pro’s and con’s before making a final decision.

Questions to ask when changing medical aids in South Africa

With 82 difference medical aid plans in South Africa, choosing the right one for you may prove to be difficult.

Whether you are looking for the most affordable medical aid, or the most comprehensive, each scheme offers something different.

We have compiled a list of questions that you can ask before changing medical aids, so that you are not faced with unexpected hurdles during the process.

When can you submit your last claim to the medical aid?

Generally speaking, most schemes allow a period of three months to submit any claims. In such cases, you may still submit your claims after your membership has been terminated.

However, you can only submit claims for medical treatment that you received while you were still a member of the medical aid.

For example, if your last month was December, you have until March to submit claims for medical costs incurred up until the end of December.

When does my current medical aid cover stop?

Because you have paid your membership contribution for the last month, you will be covered until midnight on the last day of that month.

If you have switched to another medical aid, the new cover will begin at midnight.

Will the new scheme require any specific documentation?

Yes. The following are documents which they will require

  • A membership certificate from your current medical aid, which they must provide within 30 days of the termination of your membership
  • A membership certificate from your previous medical aid, if you belonged to one before your current medical scheme
  • Completed membership application forms, including any supporting documents which they may require
  • If efforts to obtain a membership certificate have failed, a sworn affidavit stating previous membership will be required

Why is the membership certificate required?

This certificate proves continuous membership of a medical aid. If you are unable to prove membership and are older than 35, your new scheme may charge you a late joiner penalty fee.

What is a late joiner fee?

This is a penalty for those who have never been on a medical aid and are now joining, for those who have had interrupted membership for a specific period of time or for those who are joining a medical aid after the age of 35.

This fee ensures that medical aids are not able to deny members who wish to join. Furthermore, it ensures that members who have been part of the scheme are not unfairly subsidising new members.

Will there be any exclusions based on my medical history?

A medical aid may exclude you from a specified condition for a period of no longer than 12 months. This is also known as a condition-specific waiting period.

Utmost transparency regarding your medical history is extremely important. It is considered fraudulent when someone fails to disclose any relevant information regarding their medical history. Legal action will be taken in such cases.

Will I be subject to a waiting period with my new medical aid?

If your membership has been interrupted for a certain period of time or if you have joined a medical scheme for the first time, you may be subject to a 3-month waiting period. This is known as a general waiting period.

However, you will receive immediate cover for prescribed minimum benefits (PMB). PMB’s are not subject to waiting periods.

What is a prescribed minimum benefit?

Prescribed minimum benefits is a set of defined benefits which ensure that members of medical aids have access to specific minimum health services.

These benefits are accessible regardless of the medical aid plan or benefit option the member has chosen.

What are waiting periods for?

This 90-day waiting period serves to protect current members of the scheme by ensuring that new members don’t make large claims soon after joining, only to cancel their membership straight after the claim has been paid.

Will I continue to pay my membership premium during the waiting period?

Yes. You will pay your monthly membership fee throughout the entire waiting period.

Do I have to use a broker when changing medical aids?

No, it’s not necessary to use a broker. You may contact the medical aid directly via telephone, email or even online.

More tips on what to do when changing medical aids

  • Ask for a membership certificate and submit it to your new scheme along with other relevant documentation
  • Make your choice based on your health needs, benefits and contributions
  • Submit your last claims to your old scheme to ensure you make use of your benefits
  • Inform your scheme in writing of your intention to resign. Do this as soon as possible
  • Make a comprehensive medical aid comparison before choosing your new medical aid
  • Ask for your new membership card to be sent to you as soon as possible

Olemera Financial Services – Financial Planning and Medical Aids

We assist you in investigating and comparing medical aid schemes and help you choose the scheme most suited to your specific needs. Contact us today for professional assistance when changing medical aids in South Africa.

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