Cancelling your current medical aid and joining a brand new one is always a scary business. So, before you decide, read about the risks involved in moving between medical schemes. We have also included a cool video in the post where we discuss the pitfalls of hasty changes. As always, we welcome you to leave comments. Have you had any issues moving from one medical scheme to another? We would love to hear from you.
Here are a few questions that come to mind when considering a move from one scheme to another:
• What plan on the new scheme is comparable to my current one?
• Is the new scheme cheaper or the same as my current one?
• Are the benefits the same or better at the new scheme?
• Do I enjoy the same level of medical savings?
• Will my Chronic medication be covered?
But before you find answers to those questions, you need to ask this question first:
Are there any risks involved in moving from one scheme to another?
The answer to that is yes, but it’s not what you might think.
It’s important to know that no medical aid scheme can refuse you membership no matter how old you are or how unhealthy you are. Yes, they can cancel your membership but that’s only if you didn’t disclose all your medical information when applying. Always disclose your full medical history.
So, what then are the risks?
1. Paying back your medical savings account
Always remember that your medical savings account is an advance amount – think of it as credit – available to you. Savings are given to you in advance even though we haven’t yet received the contributions. It only becomes yours at the end of the year once you have paid your final installment.
Deplete your savings in month one means you still owe them eleven payments. Here’s an example:
• Your medical savings account for the year is R12, 000
• You deplete the R12, 000 in month one and decide to cancel the medical aid
• You will receive an account from the medical scheme asking for the remaining R11, 000 to be paid back
In other words, be careful if you have dipped into your medical savings account.
Take a few minutes to watch our video below:
2. Waiting Periods
If you voluntarily move from one scheme to another, then the new medical scheme may apply waiting periods as follows:
• The 3-month general waiting period, or a
• 12-month condition specific waiting period
Let’s take a closer look at each of them:
The 3-month general waiting period is a period during which you are not allowed to claim from the new scheme.
A 12-month condition specific waiting period is the period during which you are not allowed to claim for a condition where you received medical advice, diagnosis, or treatment within the 12 months prior to the new application.
These waiting periods can also apply to prescribed minimum benefits which all medical schemes must provide to their members by law.
Applying them depends on the following:
• If you are in an existing waiting period, then the new scheme cannot add to this. Only the unexpired portion of the existing waiting period may be applied at the new scheme.
• If you have not been on a scheme for more than 90 days before this application, they may apply both waiting periods which also applies to the prescribed minimum benefits.
• If you have been on a scheme for more than 90 days but has not been on a medical scheme for a continuous period of up to 24 months, the new scheme may apply a 12-month condition specific waiting period (which will not apply to the prescribed minimum benefits). They may also apply the balance of any waiting period applied by the previous scheme
• If you have been on a scheme within 90 days of applying at the new scheme, and you have had a membership for a continuous period of more than 24 months, then the new scheme may only apply a 3-month general waiting period. This will not apply to the prescribed minimum benefits.
These waiting periods apply to the main member and their adult dependants individually. You can’t remain on the previous scheme while you wait for the waiting period on the new scheme to expire.
3. Proving membership of a scheme after turning 35
You might need to prove membership of a medical scheme for every year after turning 35. If there was a break in membership, then late joiner penalties could be applied. The percentage applied will depend on how long the break in membership was. The penalty can be applied to you and any of your adult dependants individually.
If you haven’t watched our video on medical aid late joiner penalties, click here.
4. Your chronic medication might not be covered
Your doctor might have prescribed a specific chronic medication which the new scheme isn’t willing to offer. Always make sure when joining a new scheme that the chronic illness is covered and that the medicine they allow, is suitable.
If none of the above applies, then you’re good to go on the new scheme.
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