Understanding the Requirements for completing a Medical Aid Application
While the type of cover that each applicant is seeking is quite different, the process of completing a medical aid application closely parallels that of applying for an insurance policy. Both schemes operate on the basis of shared risk. That is to say, in order to maintain its operation, each of these service providers is dependent upon the statistical probability that, given a sufficiently large client base, the value of the premiums received will exceed that of the claims paid by an acceptable margin. The other difference, of course, is that in the case of an insurer, that margin represents as profit that will be paid to shareholders, whereas schemes that focus purely on healthcare cover are obliged to operate as Section 21 companies and not for profit.
When applying for car insurance, a broker will ask about the applicant’s driving experience, any previous accidents, the make, model, age, and purchase price of the vehicle that is to be insured and the extent of the cover that is required. In much the same fashion, the questions that are normally included in a medical aid application are also intended as a means to assess the type and the extent of the risk to be covered.
Unlike the motor insurer, however, companies that undertake to provide private healthcare cover are not permitted to refuse cover to an applicant. Nevertheless, a mandatory waiting period before any claims will be accepted will usually be applied to a new member, while cover for certain pre-existing conditions, such as a pregnancy, may be withheld during the first year of membership. Such restrictions may be waived for those required to change schemes due to a change of employment if such waiting condition have previously been satisfied and other benefits should apply immediately.
In this digital age, it is normally possible to obtain a number of quotes from different companies to help one compare premiums by the simple process of completing a brief online questionnaire. Since these questionnaires do not amount to a formal medical aid application, the questions are comparatively limited in their scope and any premiums quoted are intended as a guide for comparison purposed only. Thereafter, and having selected a suitable scheme, a more in-depth set of questions is likely to be required.
Most schemes offer a choice of options for private healthcare cover, each with a fixed premium that may be determined by the main member’s salary. As a result, one of the prime functions of a questionnaire will be to determine which of these products may best suit the needs of the applicant and, where applicable, those of any dependent member that may also wish to receive cover.
The Council for Medical Schemes (CMS) requires all medical aid companies operating in South Africa to provide cover for all expenses relating to a list of prescribed minimum benefits, including 25 common, chronic illnesses which, nevertheless, should be mentioned in your application.
The benefits offered by the nation’s schemes vary, as do the associated premiums and the terms and conditions that restrict them. KeyHealth focusses on relevant core benefits, understandable terms with no hidden escape clauses, and premiums that are affordable – all factors worth considering when next you complete a medical aid application.
