Joining a Medical scheme may seem to be a very complicated procedure!
But, it is not! All it needs is a little planning and some guidance ... and that is what we offer you!
Return your application to us. We will check and process it and in no time we will have you signed up!
ALL AT NO EXTRA CHARGE, because we take no fee as the medical scheme pays us!
There are 21 open schemes in South Africa that you can join and that makes choosing a plan to suit your needs very difficult!
Unfortunately, reading brochures is not going to explain all the "small print" that plan has! They may not fully answer your questions and just make you more confused.
In order to find the best affordable plan, you need consider these points ...
1. On a strict budget for healthcare?
Downgrade from high cost - high benefit plans to plans which offer good hospitalisation and small day to day benefits.
Don't bother looking outside of these plans as you'll only get an information overload!
See Different types of medical aid plans.
Complete the form on this web page if you need help.
Most schemes now offer plans that have in-hospital cover and various day-to-day benefits - all at lower premiums.
Join a plan that has:
Families can split medical plans and have younger, healthier members on lower plans, with those that require more cover on higher options.
Removing healthy dependants and only keeping those that need cover?
Choosing to join an income-based premium - plans (offering primary healthcare services) but at very affordable rates.
Consider plans that use provider networks and if you can use them, these plans do cost less than those that offer freedom of choice. The hospitals and providers are mostly all private anyway.
And that money is yours to do with as you please!
2. Ensure that the scheme is duly registered and legal. If needs be, check with the Council of Medical Schemes.
Use the Internet to find their company web page. Then check if they have contact details and a physical address.
If not, AVOID them!
3. Once you have short-listed a few interesting plans, request information about their benefits and limits, contributions and exclusions - either directly from the scheme or better, with an independant broker like ourselves.
4. Ensure that your broker is accredited by the Council for Medical Schemes and that your decision to use them was entirely yours.
A broker must provide proof of accreditation and if they do not, don't deal with them!
6. You should also check the latest financial statements and annual report of the scheme. You need to know how financially stable they are.
You can find this information on the Council of Medical Schemes or the GTC (a private company who compare schemes) web-pages.
A good starting point is a plan that offers unlimited private hospital and essential dental cover, paid by the scheme!
After that, day-to-day and wellness/loyalty benefits are negotiable when considering your budget. Make sure they reflect your member profile - like 2 adults and a child.
Answer every question in the quote enquiry as they have a material effect on the premiums.
If you are looking at joining an income-related premium plan, then you need to clearly state your income.
Give us an indication of what you can afford and any special expectations that you have about the medical aid you are looking for. Without this information, your quote will not be accurate.
Once you have all the quotes, compare costs and benefits, be ruthless and delete those that are too expensive.
Whilst we all desire the best medical aid possible, it is pointless trying to keep up with high premiums at the expense of other necessary living expenses.
Download an application for the scheme you have chosen and complete the form section by section.
Do NOT answer n/a or with a slash! Those are not answers and the application will be returned to you!
You are always required to disclose your current and previous medical history in terms of conditions and/or treatment received.
If you have difficulty understanding a question, contact me and I'll guide you further.
Additional documents the scheme may require.
You MUST make full Medical Disclosures for all the questions, as medical schemes do their homework extremely well!
If you do hide facts, however innocent, unintentional, or by mistake, it is still non-medical disclosure and the consequences can be serious. Your application may be rejected or worse accepted, based on the information you submit.
You then run the risk of a future claim being repudiated because of non-medical disclosure and you do not want that situation! You may also, be found guilty of an offence and liable on conviction to a fine, or to imprisonment.
So, be honest. You have nothing to lose!
Once the scheme receives your application it will be underwritten. They will consider your answers to the medical questions and request further information if needs be.
Depending upon your age, how long since you were last a medical aid member and how many years of past medical aid membership the adults have - since the age of 35 - so you may get a waiting period and/or late joiner penalty.
You may also be requested to see your GP to have a medical, which they will pay for.
Once finalised - which can take some time if they request additional information - you will receive an acceptance letter.
A medical scheme cannot refuse you membership, or increase your monthly contribution for any reason, outside of a late joiner penalty.
A 3 Month General Waiting Period - where the scheme may not pay anything during this time or they may pay for certain pre-defined Prescribed Minimum Benefits (PMBs) - see Medical Aid terms above.
This happens if:
The scheme will tell you before they accept you and you start paying.
You must pay contributions during waiting periods.
A pre-existing condition waiting period of up to 12 months, where nothing for that condition will be paid during the period. Thereafter, you have full access to the plan's benefits.
Waiting periods are there to protect the other members of the scheme from new members making large claims upon joining, having them paid and then leaving the scheme (called anti-selection.) Because medical schemes are not-for-profit entities, they are highly regulated. This helps to ensure that every member benefits from cross-subsidisation - where the healthy support the sick.
A Late joiner penalty - new applicants older than 35 need to prove past membership or a monthly Late Joiner Penalty is imposed. The late joiner penalty will be added to your monthly contribution and are imposed indefinitely.
An exception exists when it comes to Prescribed Minimum Benefits as you may not be refused treatment, during the waiting period, unless you have never belonged to a scheme or did not belong to a scheme for at least 90 days before you applied for membership.
No benefits can be denied on the birth of a child during the waiting period or, if you are upgrading or downgrading benefit options in-scheme or, where you had previous cover for longer than 24 months.
It is important to submit proof of every medical scheme you have been a member with, as the penalty is based upon the number of years of past membership and can be very expensive!
The penalty is not compulsory, but very few schemes will ever waive it, without proof of membership!
You can refuse to accept these counter offers and not join the scheme, but know that if a scheme does counter offer difficult terms - most other schemes are likely to do the same!
We can help you with all this "red-tape!"
We will show you how to complete your application, check it for accuracy, advise if something is missing and facilitate the process of acceptance with you.
Download application forms for leading South African medical aids directly from our site.
ALL FOR FREE - YES, NO ADDED FEE!
Some Facts to be aware of ...
(Please note, that if you pay your contribution in arrears - at month end - with the scheme you are leaving and your new scheme bills in advance - at the beginning of a month - then you will have 2 payments at the beginning of a new month. Ensure you have the funds!)
Some plans pay claims at 200% or 300% of medical aid rates, offering you a lower claim shortfall, but these are more expensive.
Increasingly, plans also have procedure co-payments, which you have to fund.
This separate insurance plan will cover most in-hospital claim shortfalls and scheme co-payments.
By adding a Top Up plan you can improve your medical aid benefits, so-much-so, that you can even consider joining a lower cost/benefit plan - with a lower premium - and still have an excellent, no risk medical aid for virtually the same premium as the higher medical aid!
We can help you with any concerns you may have, but we do need to be appointed to your plan in order to provide you with comprehensive help.
We do business by email, fax an phone at your convenience. That way everything is in writing and there are no misunderstandings.
We still use the phone as well, but an online response will be way faster than trying to set an appointment with a broker!
After s/he has gone, how much will you really remember? And email works outside of office hours!
Go back to the broker/scheme with questions, as you must FULLY UNDERSTAND the plan you are considering joining!
Any provider should welcome your questions. If you don't get answers - but still prefer that plan - then choose another broker!
You do not want to have future claims unpaid, because you never understood the rules!
Get all answers and recommendations IN WRITING, so there is no misunderstanding.
(We do everything in writing, so you can revert back to what was discussed.)
Talk to us and we'll give you your options.
You may think that you’ll never need medical cover, but considering that one episode in a private hospital can set you back hundreds of thousands of rand so, is it not better to pay a small monthly contribution to ensure you are covered?
TALK TO ME .... I am here to help you - AT NO CHARGE!
Send me your questions and concerns. I'll answer them for you.
We have a Facebook page as well ...
You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.
Medical aid pays healthcare costs.
What if a disability STOPS your income?
Last update: May 6, 2021
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Medical Aid Authority Peter Pyburn.
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