What if you can’t provide proof of previous medical aid scheme membership?

Imagine this scenario.

Man with stethoscope holds his hands in handcuffs with money in the pocket

A lady wanted to switch from her current scheme to another. They weren’t being charged late joiner penalties at all.

They submit their application and a week later the offer comes back slapping them both with 25% late joiner penalties. The monthly cost rockets from the R3, 880 I had quoted, to R4, 609 per month (What’s 750 bucks between friends anyway?). I just know I’m about to get an earful.

Why then the late joiner penalties?

When they filled in the application form, they had only entered the information for their current medical aid scheme which started in 2002. The new scheme then ‘assumed’ that they weren’t on a scheme prior to 2002.

A 25% penalty meant that the “guilty” party hadn’t been on a scheme for anywhere between 5 and 14 years.

So this is what we did.

After I got the earful, I asked her to request all their previous membership certificates. Now you can imagine that this could get complicated – neither of them is spring chickens. Her husband turned 35 way back in 1989.

But that’s when the manure hit the fan…His previous company no longer existed. No company meant no membership certificates.

So here is how we got around that:

I asked them to have a sworn affidavit witnessed by a commissioner of oaths. In the affidavit they had to state that they had both had continuous medical aid membership from the age of 35.

I sent this off to the medical aid, and voila…late joiner penalties were removed.

What’s the takeaway?

  1. When the application form asks for details of all previous medical scheme memberships, don’t just write down your current membership details. You’re not going to bypass the problem.
  2. Don’t just accept an unfair late joiner penalty. Pop down to your local police station and make that sworn affidavit. But remember, this isn’t a “get out of jail free” card. If you tell a fib, and they catch you out, they’ll cancel your membership and never allow you back.

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  1. Late joiner penalty ….my partner has never had the opportunity to have a medical aid but now we have to pay penalties…why cant we submit an affidavit stating he has been healthy all these years and had no surgeries or chronic illness, surely this would count for something instead of paying a penalty for being healthy

    • Hi Laura,

      Late joiner penalties were created in terms of the Medical Schemes Act. It applies to anyone older than 35 who was not on a medical aid from 31 March 2001 onwards.
      Since a scheme cannot prevent you from joining, the only way to protect themselves, and their members, was through the introduction of late joiner penalties.

      Its not simply a matter of being healthy and therefore waiving the penalty; it’s about protecting the existing members, who have also been healthy, and who have been contributing to the scheme over many years.

  2. I joined another medial aid two years ago from the previous one, and was given a penalty. Upon my query recently this was their response:

    “In this particular instance, the Late Joiner Penalty for yourself was calculated as follows:

    Age of member at the time of joining was 51 years – (less 35 years) = 16 years
    16 years – less the medical aid cover you had after the age of 35 years (08) = 08 years without medical aid cover.”

    Is this fair or can I still be granted waiver?

    • Hi Lee,

      The question is: Are they correct in saying that you had a period of 8 years where you weren’t a member of a medical aid since turning 35?
      If the answer is yes then we need to ask whether those 8 years were after 31 March 2001. If yes, then they can apply late joiner waiting periods.

      If this is not true, then get a sworn affidavit at a police station stating that you were indeed a member of a medical scheme since turning 35, or since 2001 if you turned 35 prior to this date.

      They won’t waive it since it doesn’t make financial sense for the scheme to do so.

  3. I have been paying a late joiner for the past four years and have joined medical aid scheme at the age of 46 years , been healthy all these years until today, but still paying the penalty.
    ombudsman must intervene in this issue because all the schemes are making a fortune out of that.

    • Hi Sibulelo,

      Late joiner penalties are provided for in terms of the Medical Schemes Act. Nothing the Ombudsman can do for you unfortunately.

  4. I have been with discovery for 9 years now. I am paying R3.000 month including the `PENALTY` I am pretty fed up with this. Thank G-d i have never been hospitalised, m on a classical hospital plan. I am 68 years old, in perfect health. I have never had to use discovery for anything!!! Why should I keep on paying this penalty??? I am a widow for a number of years now and I do find this cost VERY, VERY UNFAIR!!!

    • Hi Lee,

      I understand how you feel about late joiner penalties.There’s no getting away with it though.

      There’s also merit in what you say about never using your medical aid. If you never claim against your medical aid, shouldn’t there be some type of reversal of your late joiner penalty after a number of years? Makes sense.

  5. Hi there, I currently have a hospital plan which is called health insurance, and is not a medical aid. If I change companies after 35 and move to a medical aid will I still be liable for these penalties? Do they view these health insurance places differently to medical aids? At the end of the day I am still currently covered and have been for many years.

    • Hi Kim,

      Membership of health insurance is not recognised and you will have to pay late joiner penalties depending on how many years you haven’t been a member of a medical aid.
      You can’t compare health insurance to medical aid.

  6. Does this apply only if you’ve been on a SA registered scheme or will this work if you’ve been on a private medical aid scheme in the U.K.?