How do I make a medical aid plan change (2022)?

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You should never a medical aid change without first consulting your broker. Please note that a representative of a scheme is not the type of broker we recommend – you need an independent person who will consider your best interests at heart.

Obviously, you need to carefully consider whether your new chosen plan meets your healthcare requirements, and whether changing medical aids even makes sense. But those are not the only questions to ask. You also need to consider:

  • How will you be affected by waiting periods?
  • How will you be affected by Late Joiner Penalties
  • Can you just change plans within your scheme?
  • What is the notice period?
  • What are the cover and cost considerations for cover for your dependants, especially older children
  • What happens to your savings account, if you have one?

Medical Aid change and waiting periods

Let’s not kid. This can be complicated. Depending on your prior conditions and how long you have been a member of your medical aid, you may or may not have waiting periods.
It is not true to say that you will not be covered for pre-existing conditions if you change medical aids.
It is also not true that you will definitely have a waiting period.
Please read our “Waiting Periods” article for more detailed information, but always speak to your broker and confirm all cover limits with your scheme prior to signing the offer letter!

Medical Aid change and Late Joiner Penalties

If you pay the appropriate Late Joiner Penalty now, you will almost definitely pay one when you change schemes or plans. The LPJ stays with you for life.
There is an exception: if you get medical aid through some employer groups, the LPJ might be waived. This is a discussion for your HR department.
If you have more questions about Late Joiner Penalties, or you want to make sure yours is worked out correctly, please see our Late Joiner Penalty article.

Can you change plans within your scheme?

People change plans within their schemes mostly for two reasons: either their current plan is too expensive, or they suddenly need better benefits. In either case, your scheme will impose rules on when you can change plans.

You can always change plans without any penalties or additional waiting periods if you change plans within the same scheme on January 1 of any year.

Some plans may allow you to upgrade your plan at other times during the year, usually if you have a major life event (eg divorce, or diagnosis of cancer). Some plans may allow this but also require that you “back pay” the premium difference for the full year.

Please note: Discovery does not allow plan upgrades during the year.

Most plans – but not all – allow you to downgrade your plan at any time during the year.

What is the notice period?

If you decide to change plans to another scheme, you can do so at any time during the year, although you might have a waiting period. However, your current plan will have a notice period. This is usually a full calendar month, but can be as long as 3 months (!).

Costs and your dependants

Don’t forget that schemes treat children differently is some will only charge for a maximum of 3 children, some will charge child rates for students up to 26yrs, others will impose adult rates at 18yrs. Consider these implications, even if you have younger children, as it will eventually impact you.

Your savings account

If you currently have a savings plan and are changing to a new plan that also has one (even with a different scheme), your pro-rata balance will be transferred to that plan.

If you are moving to a plan that does not have a saving plan, your current savings pro-rata balance will be paid out to you by your old scheme, usually within 4 months.

If you have used up your savings account before the end of the year, and you change plans, you will have to pay the outstanding pro-rata balance back to the scheme.

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