While you can leave a medical and join another at any time, most medical aids have strict policies about changing your plan within the same scheme during the course of the year. This may be restricted altogether or limited according to specific criteria for a number of reasons. If you intend on changing your medical aid plan, whether you wish to move up to a higher plan or downgrade to a lower plan, it is best to do it at the year end.
Joining a medical aid is a simple process. You can either go through an accredited broker who acts as an intermediary between you and the medical aid or you can contact the medical scheme directly and request application forms. Most medical aids now have online platforms where you can enter your details and the scheme will contact you with quotes and email you the application form.
Being a member of a medical aid does not mean that you can access medical services from any provider without having to pay any cash fees. At times there is a misconception by medical aid members that a doctor or other medical service provider is forced to treat you and accept payment directly from the medical aid.
Any medical service provider in South Africa, whether a general practitioner, medical specialist, and auxilliary therapists like physiotherapists, psychologists, chiropractors and so on have the right to request cash payments for their services.
The termination of a pregnancy is the right of every expectant mother in South Africa. However, many women experience difficulty in getting the appropriate advice on the costs and facilities associated with an abortion. There are many private abortion clinics in South Africa and while government hospitals should also offer this service, the strained public health care system does not always give priority to abortions. Medical aids may cover the cost of an abortion, however, some medical aids limit the number of times the procedure may be conducted or may not cover the procedure at all.
Pregnancy is one of the times when a person reassesses their medical aid cover as the costs associated with childbirth can be expensive. Considering the high costs of private health care, it is only natural for mothers to be concerned about the extent of cover for their pregnancy and childbirth, as well as cover for any complications that may arise, especially those that can affect the baby. Proper cover is essential and ideally you should have comprehensive medical aid cover before you fall pregnant (refer to Medical Aid for Pregnant Women).
Many medical aids now offer a medical savings option on some plans which fund day-to-day medical expenses but can also be used to supplement any in-hospital costs that are not covered by your medical aid. Unlike the predefined day-to-day limits or insured out-of-hospital benefit, a medical savings account does not expire at the end of the year and can be carried over to the next year of cover.
Maternity benefits included
Pre-existing conditions covered (excl HIV/Aids)