Will I have to pay a Late Joiner Penalty?

What is it?

A late joiner penalty is a permanent penalty, added as a percentage of the base premium (not the savings portion). It is meant to dissuade or penalise people from not belonging to a medical aid in their youth, when they are presumably healthy, and joining only when they get older, and are a bigger drain on the schemes.

Therefore, members who apply for medical aid coverage and are over 35 years old may have to pay a Late Joiner Penalty.

How is it calculated?

It’s a three step process:

  • First we count out how many years it has been since you turned 35. (If you are under 35, the penalty band will not apply to you) (A)
  • Then we work out how many years you have spent on a medical aid since you turned 21. (B)
  • We then work out (A) -(B) to calculate your penalty band.

Penalty Band = (Current Age – 35) – (Years of credible medical aid coverage)

You then apply the Penalty Band to the table below:

Penalty Band: Contribution:
1-4 Premium+5%
5-14 Premium+25%
15-24 Premium+50%
25+ Premium+75%

Examples:

  • You are 43 years old, and were a member of a medical aid for 5 years, (22-27 yrs old):
    Penalty Band = (43 – 35) – (5) = 3 years = 5% penalty
  • You are 55 years old and were a member of two medical aid schemes in the past. One for 6 years (23-29 yrs) and one for 15 years (32-47yrs)
    Penalty Band= (55 – 35) – (6 + 15) = -1 = No penalty


Note:

  • The late joiner penalty is calculated as a percentage of the basic premium (not the savings portion).
  • Credible medical coverage is defined as belonging to a recognised medical aid scheme. If you cannot prove your past membership and have taken all reasonable steps to try and obtain proof, you can submit an affidavit outlining your past membership, and this has to be accepted by the scheme.
  • According to the Medical Act, if a penalty has been applied incorrectly in the past, it cannot be claimed back. However, we feel that if this was due to an error on the part of the scheme, you should discuss it with them, or the Medical Scheme Council.
  • Membership of an overseas medical aid does not count when working out the “years of credible coverage”.
  • Late joiner penalties follow members, even if they change schemes.
  • Schemes are flexible on this, and each have their own discretion on how/whether they apply the late joiner fee. Speak to them and negotiate!

We have come across a number of schemes who misrepresent how a Late Joiner Penalty is calculated, in their favor. Our explanation is taken directly from the Medical Schemes Act. Please let us know if your scheme works out the late joiner penalty differently from our formula below.


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