Below are the most essential things you need to know if you are considering joining a medical aid scheme. Follow the suggested links to learn more, and browse all the plans to find the right one for you.
Late Joiner Penalty
If you are over 35 years old, it is possible (but not definite) that you will have to pay a Late Joiner Penalty if you join a medical aid.
Waiting Periods
If you join a medical aid or if you are switching medical aid schemes (eg from Discovery Health to Bonitas), you will likely have a waiting period during which time you will have limited access to benefits.
PMBs
Understanding how Prescribed Minimum Benefits (PMBs) work is the most useful hack to get the most out of your medical aid. As you can imagine, it is complicated and obfuscated. We’ve tried to make it simpler. We have a full list of all 270 PMBs.
Quick things:
- There are two types of medical aid schemes: open and closed. Closed schemes are only available to employees of specific sectors (example: Bankmed for finance industry). Open schemes are available to everyone. Unless otherwise stated, all schemes profiled by rehealth.co.za are open schemes.
- You cannot be denied membership of an open medical aid, no matter how sick or old you are.
- Everyone pays the same price for a medical aid plan, no matter how old or sick they are. Exceptions: late joiner penalties can apply, and capitated plans that adjust premium to income.
- The maximum waiting period for a pre-existing condition is 12 months. After 12 months, you will receive full cover.
- In most circumstances, a medical scheme will give you a waiting period for pre-existing conditions. This includes pregnancy – but your newborn gets immediate, full cover on birth.
- Insurance products (hospital insurance, gap cover, primary care cover, pet insurance etc) do not fall under the medical aid rules.
- Gap Covers, which are insurance products, enhance your medical aid benefits and very often can save you a lot of money both in claims and premiums.
Medical Schemes Act.
The Act sets out what a medical aid scheme can and cannot do. All schemes have to abide by this Act, and it is the foundation of how your medical aid plan works.
Scheme Rules
Every medical scheme has its own members rules. Ask your scheme to email it to you (it’s very difficult to find these documents online!). The scheme rules cannot be in contradiction to the Act.
Council of Medical Schemes.
This body is responsible for ensuring the financial and regulatory health of the medical aid industry. If you feel your scheme is not acting in accordance to the Act or their membership agreement, you can lay a formal complain with the Council.
