Thinking of joining another medical aid scheme with better benefits?

Be very very careful!

Take the example of Joe and Mary.

They are currently on a hospital only plan. They’ve always been on medical aid, always paid their premiums, but feel that for the price they’re paying, they should be getting better benefits.

They’re on a basic hospital plan which means if they go see a doctor they need to pay for it themselves. They’ve just found out that for the same price they could be on a plan which includes things like doctor visits.

To say that Joe was angry would be an understatement. What would you have done?
Imagine if for the same price you’re paying right now, you could have had an extra R11, 000 for things like:

• Doctor visits?
• Dentists?
• Medicines?

What really made him angry was that if he didn’t touch the R11, 000 this year, then it carried over to the following year. Next year he would have the R11, 000 from this year as well as the R11, 000 for next year available – R22, 000!

But there was one small problem…

The new plan is at another medical aid scheme.
Jumping to a new medical aid means:

• they expect him to pay from day one but
• he  wouldn’t be allowed to claim for the first three months. Imagine having a serious car accident in month two?

Are they allowed to do that?

Yes they can. Many moons ago your medical scheme was allowed to reject your application or ‘load’ your monthly contribution. Yes that’s right – reject your application if you were sickly or charge you more than everyone else if you’d never bothered to belong to a scheme before.

The Act was amended and anyone could now join a scheme without being discriminated against. If you had never bothered to contribute to a scheme; you could now in your old age join a scheme and enjoy full cover. Not the kind of behavior a medical aid scheme wants to encourage.

The medical aid schemes kicked up a stink and a few concessions were granted:

• Late joiner penalties, and
• Waiting periods.

In this article we’re looking at the three month general waiting period. There is also a twelve month condition specific waiting period, but that’s for another day.

 When can’t they apply a three month general waiting period?

In one of two situations:

1. Where you’re currently a member of a medical aid scheme and you’re changing because you’re moving to another employer. You must apply within 90 days though.
2. Your employer is changing or terminating the scheme and you’re applying with the previous scheme within 90 days.

Remember that the key words here are 90 days!

When can they apply a general waiting period?

1. If you haven’t been a member of a scheme for longer than 90 days preceding your application. This also applies to the prescribed minimum benefits.
2. If you have been a member of a scheme within the past 90 days BUT have not been a member of any scheme for a continuous period of up to twenty four months. The waiting period will be the balance of any unexpired waiting period from the previous scheme.
3. If you have been on a scheme during the past 90 days – and continuously been a member of a scheme for the past 24 months – then a 3 month general waiting period may be applied. This does not apply to the prescribed minimum benefits (PMB’s). This applies if you intend on jumping ship from one company to another.

Is there a way to ‘duck and dive’ the waiting periods?

Here are some of the more popular questions which get asked:

• Does the waiting period apply to everyone on my plan? Yes
• Can you stay on your current medical aid while you wait for the new waiting period to expire? No
• Can I buy out the waiting period? No

Next time out we’ll look at a few examples of how this works in real life

In the meantime why not leave your questions below and we’ll do our best to answer them for you

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Until next time.

The InsuranceFundi Team