Its that time of the year again were we need to review our medical aid options for the following year and to submit the necessary changes through to our Medical Aids.
Medical aid year runs from 1 January to 31 December each year and your benefits according to the benefits guides are worked out in accordance to this timeframe.
Option changes are traditionally done and submitted during November each year when members after evaluating their circumstances submit option changes to the medical schemes.
When reevaluating your current circumstances on your medical aid, you must consider the following:
Will your medical expenses that you had this year be around the same for the next year, and if so, you might want to opt for a medical aid or option that provides more day-to-day benefits.
Are you in a time in your life when you might require more in hospital benefits that need to be covered including day procedures?
You might not need a pure hospital plan anymore but want something that provides some day-to-day benefits.
What happens when you change from one medical scheme to another?
You must submit a full medical aid application and include your current and past medical history and therein will include any pre-existing medical conditions and also how long you have been on a medical aid for.
Underwriting will apply to all apps, but there are certain exceptions which they will evaluate and take into consideration.
Waiting periods, why do you have them?
According to the Medical Schemes-Act, medical aids can impose a general 3 month waiting period if they see the need to. This is to protect the medical scheme against individuals that claim for costly procedures after joining, and then cancel their membership thereafter.
During this waiting period, even though your cant uses your benefits, you are required to contribute to the scheme in good faith, to show that you want to belong to the scheme.
There are two types of waiting periods:
3-month General waiting period
12-month condition specific waiting period
What is a Late Joiner Penalty which a medical scheme can impose it?
Medical aid schemes can impose a late-joiner penalty on individuals that join after the age of 35, who have never been on a medical aid, or those who have not belonged to a medical aid for a specific period of time since April 2001.
Late Joiner Penalties (LJP’s) will follow you for the rest of your life.
Each medical scheme will impose the same rate if not more pending on certain circumstances.
To avoid this, we urge clients to get onto a medical aid as soon as possible and stay on it. Even if you do an option change which is cheaper, rather go for that option as opposed to no option.
This can be from a 10% LJP all the way to a 100% LJP (Late Joiner Penalty).
Tip:
When you move from one scheme to another, ask for and keep a record of your membership certificate. You will need it for future medical schemes decisions you might make.
At Wallstreet Financial Services, we are accredited to assist you with Discovery Health, Bestmed and Bonitas Medical Scheme.
You can book a consultation with us by calling 011 608 3338 or by submitting your information through our website at www.wallstreetfs.co.za
And if you need help figuring out what kind of coverage is right for you, don't hesitate to reach out! We're here to help, and we can answer any questions you might have about our services.
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