How to Join a Medical Aid in South Africa.
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9 Steps to Finding Your Ideal Medical Aid Plan in South Africa
Joining a medical aid plan may appear complicated, but with a bit of self-investigation and expert guidance, you can choose and join a plan that meets your needs and wants.Choosing a medical aid plan in South Africa out of 21 open schemes is complicated. The “small print” hidden within brochures may leave you with more questions than answers.
Use this comprehensive guide, to help you find the right plan at the right price, get quotes, submit applications, and join a medical scheme you will be happy with.
And we charge nothing extra. Yes, you pay what you would pay going direct.
So, use us!!
What you need to do:
1: What can you afford?Try to strike a balance between cost and benefits, by looking at plans that offer the best hospital cover (your greatest risk of high expenses) at a cost that suits you.
You may even look at downgrading from a high-cost, high-benefit plan to a more balanced option.
Even look at joining an in-hospital only benefit plan and self-pay your out of hospital costs.
The premium you save by joining an in-hospital benefit plan may well pay for a Top-up/Gap plan (so boosting your in-hospital cover) and help towards your own day-to-day savings fund!
This way you cover your area of greatest risk and self-pay your essential costs yourself.
Don't let an information overload confuse you; focus only on the plans that fall within your budget.
2: Investigate different medical aid plans
Complete the form on this web page and we will show you different plan types, based on your needs and budget.
Together we can identify plans with in and out of hospital benefits - all at lower premiums.
Genesis offer a hospital option that pays unlimited costs in any hospital with essential dentistry benefits (the 2nd highest cost factor we face) all in one plan!
Fedhealth offer a day-to-day savings account that you only repay when you spend from it.
You have a hospital plan, (at a lower premium than a comprehensive plan), but with the option of savings when you need them.
And you only repay those savings, when you spend them.
3: Consider your family's needs
If you have a family, you can split medical plans and have younger, more healthy members on lower cost (lower benefit) plans and those that require more cover, on higher benefit options.
4: Affordable Primary Healthcare
Look at an income-based premium plan that offers primary healthcare services.
These plans meet your basic healthcare needs by providing essential benefits at affordable premiums.
5: Provider Networks
Plans that use provider networks ,have discounted premiums when compared to those offering full freedom of choice. Private hospitals and providers are part of these networks,,so ensuring you get quality care.
There is a big swing towards joining in-hospital only plans and taking a Gap/top-up plan to ensure up to 5 times medical aid rate cover, with procedure co-payment benefits.
You self-fund for day-to-day costs.
In many cases, the premium you save by joining an in-hospital benefit only plan will pay the top-up and contribute towards your day-to-day savings fund!
And that money is yours to do with as you please!
6: Only consider schemes that are duly registered and legal..
Check the latest financial statements and annual reports of the medical aid scheme. This will help you gauge the scheme's financial stability and reliability.
You can find these documents on the Council of Medical Schemes or the GTC (Group Risk and Insurance Consultants) websites, (a private company who GTC compare schemes) web-pages.
Visit the scheme's official website and make sure it provides valid contact details and a physical address. Avoid schemes that lack proper documentation.
7: Request Detailed Plan Information
Gather comprehensive information on your short-listed plans, including benefits, limits, contributions, and exclusions.
Seek guidance from an accredited broker to ensure accurate and unbiased information.
8: Ensure that the broker you use is accredited by the Council for Medical Schemes.
Only deal with accredited brokers to ensure reliability and professionalism.
9: Do your own online research
Use online platforms like Hellopeter or My Broadband to gather information from current and past members. Member feedback can provide valuable information on service quality and benefits.
What is needed for an accurate quote?
Get quotes for your short-listed 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 enquiry as they have a material effect on the premiums.
If you are looking at joining an income-related premium plan, then you need to clearly state your income.
Give us an indication of what you can afford and any special expectations that you have about the medical aid you are looking for. 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.
And don't make your choice based ONLY on premiums!
How to Apply
Download an application for the scheme you have chosen and 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, contact me and I'll guide you further.
Additional documents the scheme may require.
- 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.
What is non-medical disclosure?
You MUST make full Medical Disclosures for all the questions, as medical schemes do their homework extremely well!
If you do hide facts, however innocent, unintentional, or by mistake, it is still non-medical 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-medical 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.
Please - don't hide any facts and don't "twist" the truth!
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!
Medical aid underwriting
Once the scheme receives your application it will be underwritten. They will consider your answers to the medical questions and request further information if needs be.
Depending upon your age, how long since you were last a medical aid member and how many years of past medical aid membership the adults have - since the age of 35 - so you may get a waiting period and/or late joiner penalty.
You may also be requested to see your GP to have a medical, which they will pay for.
Once finalised - which can take some time if they request additional information - you will receive an acceptance letter.
A medical scheme cannot refuse you membership, or increase your monthly contribution for any reason, outside of a late joiner penalty.
What to do about a counter offer letter?
A counter offer letter may include waiting periods and a late joiner penalty.
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.
This happens if:
- you have not been a member of a South African medical scheme for the past 90 days or longer, before applying for membership.
- you voluntarily change medical schemes and have not been on your previous scheme for a period of 2 years or more.
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.
An exception exists 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.
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.) Medical schemes are not-for-profit entities and 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 are imposed indefinitely.
An exception exists 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.
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.
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!
The penalty 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!
We can help you with all this "red-tape!"
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.
Download application forms for leading South African medical aids directly from our site.
- A true dependant of yours cannot be refused membership.
- Membership cannot be cancelled unless premiums are not paid and debts to the scheme are outstanding or, if you have been found guilty of trying to defraud the scheme in some way.
- Non-Medical Disclosure is the leading reason for membership cancellation.
- You can join a scheme at any time, however changing plans within a scheme can be restricted outside of the year-end.
- Generally, plan benefits and premiums remain as is for the calendar year.
- Contribution increases typically occur at the beginning of the new year.
- You may not belong to more than one scheme simultaneously
- Most medical schemes require 30-calendar days notice, so you need to coordinate your leaving one scheme and starting another. (Yet again, something we will do for you!)
- Cash pay-outs of medical savings accounts are not allowed by law, except after you have left that scheme, except after you have left that scheme.
- Most schemes have online access through a mobile application.
Take time to work with it as it will save you time and give you virtually instant answers.
Private healthcare providers charging up to 500% of the medical scheme rates and the increasing trend of medical aids including procedure co-payments is a significant concern for medical aid members.Protect yourself against these potential threats, by joining a GAP or top-up insurance plan
This separate insurance plan acts as a protective shield, covering most of the in-hospital claim shortfalls and any co-payments you may face and provides a valuable safety net, ensuring that you have adequate benefits for medical treatments without having to bear the full brunt of unexpected costs.
Don't leave yourself vulnerable to sky-rocketing medical expenses; instead, empower yourself with comprehensive benefits that bridges the gap between medical scheme rates and private provider charges.
Specialised Dental treatments can be extremely expensive!The costs of braces, root canal, implants and so on, can run into thousands of rand. Most treatments are done out of hospital, so are funded from your savings. That can result in less money available for other medical needs and family limits being used on one member only!
Dental treatment is something we all need and it is vital you consider the Best Dental Insurance Plan OR Most Affordable Dental Planin South Africa.
No Medical Aid or have a Hospital Plan only? This plan will help you meet the high costs of both normal and specialised dentistry!
We can help you with any concerns you may have with an existing medical aid, but we do need to be appointed to your plan in order to provide you with comprehensive help.
Get all your answers and recommendations in writing, so there is no misunderstanding.
(We do everything in writing, so you can revert back to what was discussed.)
Talk to me .... I am here to help you - at no charge!
Send me your questions and concerns. I'll answer them for you.
083 655 2164
You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.
We will offer you the best help at no cost!
Medical aid pays healthcare costs.
What if a disability stops your income?
YOUR TRUSTED, QUALIFIED ADVISOR:
Peter Pyburn - Authorised Financial Services Provider, fully licensed to render financial services since 1991. Death and Disability Planning; Retirement Planning; Investment Planning; Healthcare and Estate Planning.
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Last date: January 18, 2025