Members who apply for medical aid coverage and are over 35 years old may have to pay a Late Joiner Penalty. Note: We have come across a number of schemes who misrepresent how a Late Joiner Penalty is calculated, in their favor. Our explanation below is taken directly from the Medical Schemes Act. Please let us know if your scheme works out the late joiner penalty differently from our...
No, you can apply to become a member of any Medical Scheme directly to the scheme. Some schemes don't work with medical aid brokers at all. How much does a medical aid broker cost? A broker does not cost you, the member, anything. Your premiums do not differ if you have a broker than if you don't. The Medical Aid pays the broker directly. The Medical Aid Act dictates...
Do you have a complaint with your medical aid? Start by speaking to your Medical Scheme. Put all your communication in writing. Some Schemes will have an appointed person who deals with escalated queries or complaints. if your complaint is not resolved, ask your Scheme who within their organisation this can be escalated to. As a last resort, you can contact the Council of Medical Schemes. This is a...
Determining when you can change your medical plan depends on whether you want to stay with the same scheme or not. If you want to stay with the same Scheme, but want to change plans, you can usually do so by December 31st, for the following year. Some Schemes have deadlines earlier than this, so please check with your scheme (you should receive written communication from the scheme informing...
Waiting Periods are imposed by the Medical Aid scheme on new members, based on their medical history or their history with medical aid coverage. The Medical Act allows waiting periods to be imposed so as to prevent potential members from joining a scheme as they become ill. The idea is that members should join a scheme while they are generally healthy. It is, however, freely admitted by the department...
No. A medical scheme is not allowed to refuse you membership, including on the grounds of past-ill health, or you being a high risk. A scheme, can, however impose waiting periods. A scheme is also not allowed to charge you a different (higher) premium because of your past medical history. It can, however, impose a "late-joiner" penalty, which can range from an extra 5% to 75% of the premium,...
Changing a plan within the same Scheme You can usually do this at the end of the calendar year, for the following year. Each Scheme has different rules, so you should check with yours to make sure you are compliant. Most often, you will be requested to fill out a "Change of plan" form, which you simply need to submit by the deadline. Of course, if you have a broker,...
DSP A Designated Service Provider (DSP) is a healthcare provider (doctor, pharmacist, hospital, etc) that is a medical scheme’s first choice when its members need diagnosis, treatment or care for a PMB condition (see below for definition of PMBs). (source: Council for Medical Schemes) Extended Benefit This is “extra” coverage for a benefit, that is paid for by the scheme and not out of your medical savings. The Medical Aid Bible ...

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