Sounds like a silly question, right? But is it really?
Think about it.
Let’s say you’ve been on Discovery Health all these years. You’re a Vitality member, gold status nogal. You pound the gym every day of your life except Sundays, and now you’re forced to cancel and join a scheme with none of these benefits…
Chances are you’re going to be a tad upset.
Getting back to our original question, the answer to that is yes and no, but it all depends on how you answer the following question:
Is it compulsory for me to join the medical aid scheme?
Large companies usually offer a compulsory membership medical aid scheme. Compulsory meaning exactly what it says – the opposite of optional.
Smaller companies normally offer a voluntary membership medical aid scheme. Here the employee has the option of belonging to the scheme.
Joining a compulsory scheme does have advantages. One of these is limited underwriting which depends on:
- The number of employees on the employer group scheme (10 or more is good), and
- The medical scheme in question as each scheme has its own rules.
What do we mean by limited underwriting? Well when you join as an individual, they underwrite you as an individual. This means:
- Lack of previous membership means a 3 month general waiting period
- Pre-existing medical conditions means a 12 month condition specific waiting period.
- Late joiner penalties are also applied where applicable
For the person who:
- Hasn’t been on a scheme in the past 90 days,
- Who has serious health issues, or
- Who is facing some serious late joiner penalties,
A compulsory medical aid scheme is the way to go.
But let’s assume, for whatever reason you don’t wish to join your company’s compulsory medical scheme. Are there options?
Three scenarios spring to mind:
The existing employee
This is the chap who worked for his employer long before the thought of implementing a compulsory membership scheme crossed the mind of his employer.
You can’t turn around at this stage and force the employee to pay for something he doesn’t want. By all means, offer him the opportunity to join, but you as employer cannot force him.
The new employee
Generally speaking, this person has no option. It forms part of his employment contract. You want the job; you join the scheme, capisce (understand)?
Usually there’s an escape clause though, so let’s get to that.
The new employee who is an adult dependant on another scheme
Firstly, what if your spouse is already a member of her company’s medical scheme?
If you aren’t already, you could always join your spouse’s medical aid scheme as a dependant. Of course, you’d need to submit proof to your new employer.
What if you were a member of a medical scheme in your individual capacity?
The only solution is to switch the main member at your existing scheme:
- From being yourself
- To your spouse.
- With you then becoming an adult dependant on their plan.
Then pop off proof of this to your new employer and hold thumbs.
The big question you need to ask:
“Is the medical aid scheme at my new employer better than my current scheme?”
If the answer to that is no, then the next question is:
“Do I have a spouse on the existing scheme so that I can get out of this?”
If that answer is yes, then as long as you’re a dependant on their scheme, you’re in the clear.
If you’re single however, then you’re fresh out of options.
Until next time.
The InsuranceFundi Team
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