Wherever possible, consumers are tightening their belts and looking at ways to consolidate expenses and save money. Healthcare is no exception.
Traditionally, members of medical aids re-evaluated their medical cover annually, to coincide with increase announcements as well as changes to plans and benefits which come into effect on January 1 each year. However due to the pandemic, a number of medical aid schemes have deferred or postponed their increase announcements. This new pricing is being introduced at different times during the year and at varying percentages – often above inflation.
‘This has caused some confusion and challenges,’ says Lee Callakoppen, Principal Officer of Bonitas Medical Fund – which opted not to defer increases.
‘Members are free to change their options, once a year, during the open period. However, with deferred increases, this often falls out of the open period. This means members start paying the increased premium after to change options has closed.’
Callakoppen explains that the medical aid industry is highly regulated with specific rules and regulations that could impact changing plans and moving schemes. These include waiting periods, late joiner fees and accumulated savings – that all need to be considered when changing plans
Can you change your membership any time during the year?
You can change at any time but usually this happens during open period. When changing, waiting periods might apply and the savings allocation of the plan may be affected. Make sure you have not already used more than a pro-rated percentage of the benefits or you might have to replay it. This will happen if you have depleted the savings’ portion before the end of the year and switch to another medical aid.
What is a waiting period?
According to the Medical Schemes Act, medical aid schemes are entitled to impose waiting periods – there are two categories: General waiting period (up to three months) and a condition-specific waiting period (up to 12 months).
This protects other members of the Scheme by ensuring individuals can’t make large claims shortly after joining and then cancelling their membership.
When do waiting periods apply?
Waiting periods generally apply if you move from one medical aid to another, you or your dependants were not on a medical aid for a period of at least 90 days before you joined, or you have never been a member of a medical aid.
Can these be waivered?
Waiting periods can be waivered but this depends on the medical scheme.
Do you pay premiums during a waiting period?
Yes, you continue to pay your full premium during the waiting period.
What if you change from one scheme to another?
Your specific details and medical history will be considered, for example pre-existing medical conditions, how long you have belonged to a medical aid, etc., and underwriting may apply.
What is a late-joiner penalty?
Schemes can impose late-joiner penalties on individuals who join after the age of 35, who have never been medical aid members or those who have not belonged to a medical aid for a specified period of time since April 2001.
Can you move directly from hospital insurance to medical aid?
Late-joiner penalties will apply if you are over the age of 35 and move from a hospital insurance to any form of medical aid (including a hospital plan).
Does the late-joiner penal reduce over time?
No, unfortunately not. Once you are paying a late-joiner penalty, it remains in place.
‘The bottom line is that members need to do due diligence if they are considering switching medical plans or schemes. They need to evaluate the monthly contribution against the benefits being offered and make sure they will cover their healthcare needs,’ says Callakoppen.