SA's No 1 Insurance Blog


You’ve left one medical scheme to join another. When joining the new medical scheme, you opted for a plan without a medical savings facility (you’ve decided you just need to cover your in-hospital related expenses and self-fund the rest). Because you’ve made that decision your previous scheme needs to pay out your accumulated medical savings. It is after all your moola! But the problem is that it’s taking forever! Why is that?

Don’t worry you will get your hands on the cash. The reason why your medical scheme is holding onto the money is simply because providers have 120 days (4 months) to submit claims to your scheme. And it’s pretty obvious that if your scheme paid your savings out to you, the minute you left them, they would have major problems paying out late claims.

“Mr Els, It’s medical scheme x here. About that R7000 we paid out to you. It seems we received a late claim from Hospital Y. We need R2500 of that money back. Uhhm, I don’t have the money anymore. It’s been invested in a new mountain bicycle for my son!”

You see where I am going with this..

So, your medical scheme holds onto your medical savings for around (5) months before they square off with you. Well, that’s if you’ve either:

  1. Left their scheme and decided not to join another medical scheme altogether.
  2. Left their scheme and decided to join a medical scheme plan without a medical savings facility

But….

If you have left one medical scheme to join another and both plans (your previous one and the new scheme plan) have a medical savings facility the money cannot be paid out to you because by law it needs to be transferred over to the new scheme.

“Hold on a second Brendan! Let me get this right. If I belong to a medical scheme and I’ve got R7000 built up in my medical savings account, and I opt for a medical aid plan with my new scheme that also has a savings facility, do those savings need to be transferred over? After the waiting period is up?”

Spot on. It’s a statutory requirement.

Here it is again before I wrap up.

  • Leave your medical scheme and don’t join another and your scheme needs to pay the balance of your medical savings account out to you.
  •  Leave your medical scheme and join another scheme but you opt for a plan that doesn’t have a medical savings facility – then the money pays out to you.
  •  Leave your medical scheme and join another scheme and both plans have a medical savings facility – then the savings needs to be transferred across from your old scheme to your new scheme (by law)

Are you interested in joining a medical aid scheme?

Kind regards,

The InsuranceFundi Team

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