19 November 2012

Changing your medical scheme

Know the facts before you change medical scheme. Take the right steps to make the change quick and easy, without compromising your cover. Here's how to do this.


Thinking about changing medical aid schemes? You’re not alone. Thousands of South Africans change schemes every year because they feel they aren’t getting the service, benefits or level of cover they require from their medical aid provider.

If you’re unhappy with your current medical scheme, the good news is that you can switch to a new scheme at any time. Just be sure you know the facts before you change, and that you follow the right steps in order to make the change as quick and easy as possible, without compromising your cover.

Here are 10 tips on choosing the right medical scheme.

Things to know before changing medical aids
The most important thing to be aware of is that it’s not legal to be a member of more than one medical aid scheme at a single time. This means that you must resign from your current medical aid scheme before joining another. It doesn’t mean, however, that you need to go through any period of time without medical cover.

Contact your current provider to let them know that you wish to resign from their scheme. You may have to do this in writing. Find out when your cover will terminate (usually at the end of the following month, but this may differ from scheme to scheme), and then ensure that your new medical scheme plan commences the day after your old plan terminates. Thus, if Scheme A’s cover terminates on 30 November, make sure that Scheme B’s cover commences on 1 December.

Waiting periods
As soon as cover commences with Scheme B, you’ll enjoy the benefits offered by the particular plan you’ve chosen. If you have a chronic ailment or pre-existing condition, your new medical aid scheme may impose a waiting period of 3 or 12months on this condition. However, if your ailment falls under the list of PMB chronic conditions, you could be covered for it immediately.

Bear in mind that if you or a dependent falls pregnant before joining a medical aid, the pregnancy may not be covered by the scheme. This is to protect existing members against the phenomenon of people joining a medical scheme just to receive cover for a specific condition or medical requirement (i.e: pregnancy, a planned operation, etc), and then resigning again afterwards, saddling existing members with those costs.

Choosing the best benefits
Before making the change, consider your reasons for switching, and be sure that your new medical aid scheme does in fact offer the benefits you need or the specific level of cover you require. Think carefully before switching for things like cheap movie tickets or airline discounts – often, these frills aren’t free, and they may mean that you receive less cover where it really counts.

When choosing a new medical scheme, factors to consider include the specific benefits and level of cover offered; the reputation and stability of the scheme, and the level of member service. Price is also a factor, but remember that the cheapest medical schemes aren’t always the best. 

Making the change
The actual switch from one medical schemeto another requires very little admin. You may need to resign from your current medical aid in writing, and joining a new scheme will mean filling in and signing a form . Once you’ve received confirmation from both schemes, your old medical scheme will terminate and your new one will begin on the specified dates.

There’s no reason to stay with a medical scheme that you aren’t happy with. Rather change medical schemes and enjoy the benefits, cover and service that you deserve.

(This article was provided by Selfmed Medical Scheme).

Read more about medical schemes.

(Picture: Medical finance from Shutterstock)



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