With that number of plans on offer, it is extremely difficult to choose a plan to best suit your needs! Reading brochures is not going to explain all the "small print" that plan has!
The high cost of medical aid is increasingly shifting members to downgrade choices from high cost - high benefit plans to plans which offer good hospitalisation, with a small day to day benefits.
As a result schemes now offer plans that have excellent in-hospital cover and various day-to-day benefits - all at lower premiums.
Plans that have:
- a co-payment when you use out of hospital benefits, or
- savings that are allocated to you only when you need them, or
- hospital plans that pay dentistry (the 2nd highest cost factor we face) as well.
Some families split medical plans and have younger, healthier members on lower plans, with those that require more cover on higher options. This is allowed.
Blue collar workers are starting to remove healthy dependents and only keep those that claim frequently on their plans.
Even more are choosing income-based premium - network plans (offering primary healthcare services) but at very affordable rates.
Look at the provider networks and if you can use them, these plans do cost less than those that offer freedom of choice. The hospitals and providers are mostly all private anyway.
There is a big swing towards joining in-hospital only plans and taking a Gap/Top up plan to ensure that the highest rate of in-hospital cover is provided, with co-payments being paid.
You then self-fund for day-to-day costs.
Use the Internet to find their company web page. Then check if they have contact details and a physical address. If not, AVOID them!
Ensure that your broker is accredited by the Council for Medical Schemes and that your decision to use them was entirely yours. A broker must provide proof of accreditation and if they do not, don't deal with them!
You should also check the latest financial statements and annual report of the scheme. You need to know how financially stable they are.
You can find this information on the Council of Medical Schemes or the GTC (a private company who compare schemes) web-pages.
Get quotes for those plans.
A good starting point is a plan that offers unlimited private hospital and essential dental cover, paid by the scheme!
After that, day-to-day and wellness/loyalty benefits are negotiable when considering your budget.
Make sure they reflect your member profile - like 2 adults and a child.
Answer every question in the quote.
There are a number of points that can lead to additional premiums like, the age of dependents, how long since you were on a medical scheme and how many years of past medical aid membership the adults have - since the age of 35. This is the waiting period.
If you are looking at joining an income-related premium plan, then you need to clearly state your income.
Try give us an indication of your budget and any special expectations that you have about the medical aid.
Without this information, your quote will not be accurate.
Once you have all the quotes, compare costs and benefits. Be ruthless and delete those that are too expensive.
Whilst we all desire the best medical aid possible, it is pointless trying to keep up with high premiums at the expense of other necessary living expenses.
Don't make your choice based ONLY on premiums!
Download an application for the scheme you have chosen. Complete the form section by section.
Do NOT answer n/a or with a slash! Those are not answers and the application will be returned to you!
You are always required to disclose your current and previous medical history in terms of conditions and/or treatment received.
If you have difficulty understanding a question, email me and I'll guide you further.
Additional documents the scheme may require.
You need to submit supporting documents like ID or birth certificates for all applicants, adoption papers, court orders for dependency and/or divorce, marriage certificates if names are different.
Income-related plans require proof of income.
To avoid late penalties and possible waiting periods, please submit current and past medical aid certificates or a sworn affidavit with medical scheme names, start and termination dates.
Student plans require proof of full-time study registration, at a recognised tertiary institution.
All our applications include instructions on completing the application and what to submit.
If you do hide facts, however innocent, unintentional, or by mistake, it is still non-disclosure and the consequences can be serious. Your application may be rejected or worse accepted, based on the information you submit.
You then run the risk of a future claim being repudiated because of non-disclosure and you do not want that situation!
You may also, be found guilty of an offence and liable on conviction to a fine, or to imprisonment.
So please - don't hide any facts and don't "twist" the truth!
Generally, medical schemes don’t need to investigate your previous medical history when you apply. However, if you apply for elective (not emergency) hospital or chronic benefits within your first year of membership and there is no reference to a condition in your application, they may inquire about that situation.
Remember, you sign your application confirming that your answers and that all information supplied is true, correct and complete in every respect. You also, give permission for your medical providers to disclose your medical information to the scheme.
So, be honest. You have nothing to lose!
They may also, request you see your GP to have a medical, which they will pay for.
When the underwriting is finalised - which can take some time if they request additional information from you - a decision on the terms for accepting you is made. Generally, there is no problem and acceptance is granted.
A medical scheme cannot refuse you membership, or increase your monthly contribution for any reason, outside of a late joiner penalty.
However, they can impose waiting periods and if this is the case, you will get a "counter offer" letter, detailing the terms and conditions of their offer to you.
A 3 Month General Waiting Period - where the scheme may not pay anything during this time or they may pay for certain pre-defined Prescribed Minimum Benefits (PMBs) - see Medical Aid terms above.
It will be imposed:
- if you have not been a member of a South African medical scheme for the past 90 days or longer, before applying for membership.
- if you voluntarily change medical schemes and have not been on your previous scheme for a period of 2 years or more.
During a general waiting period you may have no cover (even Prescribed Minimum Benefits (PMBs). The scheme will tell you before they accept you and you start paying.
You must pay contributions during waiting periods.
A pre-existing condition waiting period of up to 12 months, where nothing for that condition will be paid during the period. Thereafter, you have full access to the plan's benefits.
Waiting periods are there to protect the other members of the scheme from new members making large claims upon joining, having them paid and then leaving the scheme (called anti-selection.)
Because medical schemes are not-for-profit entities, they are highly regulated. This helps to ensure that every member benefits from cross-subsidisation - where the healthy support the sick.
A Late joiner penalty - new applicants older than 35 need to prove past membership or a monthly Late Joiner Penalty is imposed. The late joiner penalty will be added to your monthly contribution and does not expire after a certain amount of time as is the case with waiting periods. The penalties are imposed indefinitely.
There is an exception when it comes to Prescribed Minimum Benefits as you may not be refused treatment, during the waiting period, unless you have never belonged to a scheme or did not belong to a scheme for at least 90 days before you applied for membership.
In addition, no benefits can be denied on the birth of a child during the waiting period or, if you are upgrading or downgrading benefit options in-scheme or, where you had previous cover for longer than 24 months.
So, it is important to submit proof of every medical scheme you have been a member with, as the penalty is based upon the number of years of past membership and can be very expensive!
It is not compulsory, but very few schemes will ever waive it, without proof of membership!
You can refuse to accept these counter offers and not join the scheme, but know that if a scheme does counter offer difficult terms - most other schemes are likely to do the same!
Make your application process simple by using us!
We will show you how to complete your application, check it for accuracy, advise if something is missing and facilitate the process of acceptance with you.
You can Also, download application forms for leading South African medical aids directly from our site.
Take time to work with it as it will save you time and give you virtually instant answers!
If you don't want to, then we can help you if you are listed with us.
Email works outside of office hours!
Go back to the broker/scheme with questions, as you must FULLY UNDERSTAND the plan you are considering joining!
Any provider should welcome your questions. If you don't get answers - but still prefer that plan - then choose another broker!
You do not want to have future claims unpaid, because you never understood the rules!
Get all answers and recommendations IN WRITING, so there is no misunderstanding.
(We do everything in writing, so you can revert back to what was discussed.)
You may think that you’ll never need medical cover, but considering that one episode in a private hospital can set you back hundreds of thousands of rand so, is it not better to pay a small monthly contribution to ensure you are covered?