In most cases, we can manage the odd bout of flu, winter cold or tension headache with no more than a bit of rest and some over-the-counter medication. However, the Covid-19 pandemic has since taught us that even an illness that begins with a few relatively mild symptoms can quickly escalate into a life-threatening condition that could require treatment in an intensive care unit. South Africa’s medical aid schemes were introduced to help households with limited incomes cope with the high and steadily rising cost of private healthcare services.
The once enviable public healthcare service was burdened by the lack of a compulsory contributory policy and the added expense of providing services to cater separately for each racial group. Long waiting lists and limited facilities drove most of those who could afford it to seek treatment in the private sector. However, those with insufficient income could not hope to meet the high cost of private healthcare, so South Africa introduced the medical aid scheme. Most are now closed schemes, restricting membership to designated groups, such as the employees of a named company or members of a particular professional body. However, around a quarter of the country’s schemes are open, providing self-employed and uninsured individuals plenty of choices and the freedom to switch providers if they so wish.
Considerations when Switching Your Medical Aid
Whether open or closed, these schemes operate on the same basis as insurance companies, relying on a statistical principle known as shared risk. Only a relatively small percentage of members will make large or multiple claims from their medical aid provider. The premium payments of the majority should amply cover these and leave some cash in reserve. Scheme managers must seek approval from a regulatory body before increasing their monthly premiums. However, annual increases are the rule rather than the exception. They often spur members to look for cheaper cover with another provider.
A member of an open scheme is free to switch at any time. However, there are a few things one needs to be aware of when planning to do so. Perhaps you are happy to remain with your existing medical aid company and merely wish to switch to a cheaper product. You will be free to do so, but only at the beginning of the new membership year. Although you can change providers whenever you wish, there are several other factors you will need to consider.
Outstanding Claims and Termination of Cover
Firstly, suppose you have an outstanding claim. In that case, you will generally be required to submit it within three months from the date of your relevant service. The timing may vary between schemes, so be sure to check. You will continue to be covered by your current medical aid provider until midnight on the last day of the month during which you gave notice. Your new cover will commence from midnight on the day of enrolment and will last until year-end, regardless of the start date, unless renewed.
In addition to completing a membership application form, you must also submit a membership certificate from your previous provider or an affidavit if you cannot obtain one for any reason. If you fail to provide proof of continuous membership and are older than 35, your new medical aid scheme could impose a late joiner penalty fee.
If you can prove continuity, your cover should commence immediately. If you can’t, you will be treated as a first-time member. You will face a three-month waiting period before you can make claims unless they relate to a prescribed minimum benefit (PMB). The 90-day wait prevents new members from submitting large claims and terminating their membership once they receive payment.
Should you have an existing illness not covered as a PMB, it will generally be 12 months before you can claim from your new medical aid scheme for that particular condition. However, all other benefits will apply from day one or after three months as applicable.
Choose KeyHealth for Affordable, Trusted and Proven Cover
While knowing the membership requirements and complying with them is essential, it is equally necessary to choose your new provider and cover option with care. You want a medical aid you can trust and a product you can afford that meets your expected healthcare requirements. That’s why so many South Africans choose one of the nation’s oldest and largest. Check out KeyHealth and our range of medical aid products to ensure your family will enjoy the protection of affordable, trusted and proven private healthcare cover.