How to Change your Medical Aid Plan

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.

Why Change Your Medical Aid Plan

There are many reasons why a member may consider changing their medical aid plan. You may consider upgrading if your medical needs are increasing and you have more money available to purchase better cover. When times are tough, you may want to downgrade to a cheaper plan without giving up medical aid cover altogether. However, jumping between plans can have drawbacks if you decide to do it mid year.

Medical aids have caught up with the tactics of members in getting the most out of the scheme with the least amount of contributions. Some members have upped their plans only to use the additional benefits and then downgraded again once they no longer need that level of cover. This is one of the main reasons that medical aids discourage members from changing their plan midway.

Remember that medical aids structure your annual benefits based on the total contributions they will collect from you during that year. If you join mid year, then you will receive the pro rata benefit although you still have to pay the full monthly contribution. You may find that this actually works against you.

Changing Your Medical Aid Plan

If you are on a company medical aid scheme, you will have to speak to your employer or the HR department about changing your plan. Your option also impacts on your employer’s contributions so this has to be discussed at the outset. If you employer is not prepared to pay for the difference, you will be liable for the additional cost of increasing your medical cover.

In other cases, you can choose when you want to increase your cover and all you need to so is speak to your scheme.  This can at times be done telephonically although you may need to sign a new debit order form to approve the new monthly contribution.

Many medical aids will refuse to allow you to change your plan mid year. Even though you may argue that it is your contribution and therefore your decision, your medical aid does not have to necessarily allow this change of plan. As mentioned above, you have bought cover for a year based on the contributions that you could afford. Your medical aid simply allowed you to pay for this on a month to month basis.

Some of the better medical aids in South Africa do have bridging options should they not allow you to change you plan midway through the year. You can purchase additional health cover by increasing your savings contribution or a related top up cover till the year end. If you are considering hopping over to an entirely different medical aid scheme, you may find that it will not work in your favour to join mid-year. A three month waiting period may be instituted by the new medical aid and pre-existing conditions may be liable for up to a one year hold.

Another option to ensure greater cover if you are hospitalised is to sign up for a hospital cash back plan. Theis type of insurance plan is not a medical aid but you will be reimbursed on for every day that you are in hospital. You can use this extra cash to pay for your medical bills.  Always speak to your medical scheme about the various options for changing your level of cover. An accredited medical aid broker may be in a better position to advise you based on your needs and budget.