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.
Medical aid cover is somewhat of an essential insurance if you want to access quality health care services. Even if you are young and healthy, you may fall ill at any time, be a victim of crime or have an accident. When you need health care, you want the best medical services available and despite the government’s best efforts to provide quality care, the public health system is overburdened and understaffed. The possibility of a labour strike or budget cuts may mean that you are at the mercy of those with wage disputes or a lack of resources. A medical aid is the way to ensure that you have access to quality health care at any time.
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.
A company medical aid is any medical scheme cover subsidised by the employer. Sometimes this is cover on a restricted or closed medical aid which is only available to employees of a specific company or sector of industry. At other times, employers may subsidise monthly medical aid contributions for their employees on open medical aids.
Employers are not obliged to subsidise medical aid cover for their employees and this perk should not be confused with other mandatory benefits like UIF (unemployment insurance fund).
A hospital plan is medical aid cover that provides benefits for in-hospital (inpatient) visits and procedures. Most medical aid hospital plans also provide chronic medication cover. Private health care is expensive and hospital costs are staggering should you not have medical aid cover. A hospital plan is not a complete medical aid with day-to-day cover and out-of-hospital benefits but it is a cost-effective option for medical care should you require hospitalisation.
What is a Medical Aid Hospital Plan?
A hospital plan is a form of medical aid cover that provides benefits in the event that you are hospitalised. Medical aid hospital plans will pay for the doctor’s consultation fees, procedure costs, investigations and tests, medicines and your hospital stay.
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Maternity benefits included
Pre-existing conditions covered (excl HIV/Aids)