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SA's No 1 Insurance Blog

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So why the silly title, “Chronic diseases, medical aids, and waiting periods”?

It all became very relevant to us a little over a month ago when one of our clients suffered a health scare.

It all started with an aching pain in the chest which steadily got worse as the day progressed. It involved an ambulance chase to the closest private hospital.

And it ended with some good and some bad news.

The good news was the diagnosis – a simple anxiety attack. The bad news – it cost them over R20, 000 for the diagnosis.

Look, for most of us the last thing we can afford is to waste R20, 000. But isn’t it funny that when our health suddenly fails, we’ll do anything to get healthy again, even if that means selling our homes.

This couple were fortunate enough to come through relatively unscathed. Do you want to know what’s the first thing they did when he was released? They signed up for medical aid.

But every good story always has a problem.

A week after their application was sent in they received a counteroffer from the medical aid – waiting periods had been applied. Look, waiting periods go with the territory, and they knew they’d be coming, but they were unprepared for this.

First there was the  three month general waiting period.

Basically they were expected to pay for 3 whole months before ever being allowed to claim under the medical aid. In their case it was R6, 000 spent with absolutely no return. Have a car accident during the 3 months? Sorry, we won’t help you!

Then came the 12 month waiting periods.

Anything and everything related to hypertension was excluded for 12 whole months. You name it:, but it wasn’t just hypertension…

  • hypertensive heart and renal failuresexcluded
  • Brain haemorrhage caused by hypertensionexcluded
  • Cerebrovascular disease and strokeexcluded

And here’s the worst part of their story…

The prescribed minimum benefits were also excluded.

“But hang on!” I hear you say. “They can’t exclude PMB’s (Prescribed minimum benefits) can they? After all, they are prescribed, aren’t they?”

Well it turns out that yes they can.
Now before I explain why they’re allowed to do this; you need to understand that this couple were already spending a R1, 000 a month on chronic medications. Add to this the cost of the medical aid, and the fact that this additional cost was going to have to be carried for the next 12 months.

Think about it. We’re talking of R3, 000 a month for the next 12 months for half a medical aid. Their biggest reason for wanting medical aid wasn’t being covered.

This is what section 29a of the Medical Schemes Act has to say:

If a person has not been a beneficiary of a scheme (read member there) for a period of more than 90 days preceding an application to a scheme, the scheme may impose the following waiting periods:

  • a three month general waiting period, and
  • a 12 month condition specific waiting period (So if you had a heart condition before applying then this was excluded for a full year)

These waiting periods will also apply to any treatment falling under the PMB’s.

So what’s the takeaway?

Get yourself onto a medical scheme before the lifestyle diseases hit home. Don’t wait till a health scare hits you or a member of your family, and then decide to join.

You’re spending a small fortune insuring that piece of metal you drive to work every day, aren’t you? So why not make sure the most important thing you own – your body and its ability to earn an income – are looked after just as much.

Are you interested in getting a medical aid quote?

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Until next time.

The InsuranceFundi Team


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