Many people living with disabilities are as healthy, if not more so, than a person without any handicap. However, not all disabled people are able to take care of themselves or function to such a high degree. The medical costs for a person who is physically disabled and/or mentally handicapped can be significantly more as the level of functioning can predispose one to more accidents, infections and other illnesses.
Apart from the medical costs directly related to the disability, a person who is not physically active may be more likely to suffer with high cholesterol, recurrent infections like the colds and flu or have other complications related to the limited movement. In terms of mental disability, the person may be more prone to accidents which could increase the costs of medical care. Medical aid may be the best solution so as to limit the financial impact on parents and caregivers.
Medical Aid Premiums for the Disabled
Most medical aids will not increase the cost of cover purely based on a disability. This may vary among medical aids, but if a disabled person is under the age of 35 years, has no chronic conditions and is healthy, there should be no difference in medical aid premiums from that of a person of the same age and health status with no handicap.
Medical Aid Exclusions for the Handicapped
Although the premiums may be the same, most medical aids will exclude cover for any condition, equipment or medication for a pre-existing condition. This usually applies for the first year of cover, sometimes longer, but it is best to speak to the medical aid directly and clarify this issue. Exclusion rules are not isolated only to the handicap. It is applied across the board to any person with a pre-existing condition, whether you have a disability or not. Those expenses that are not covered by your medical aid may be considered for tax exclusions depending on th extent of disability and relevance of the costs.
Immediate Benefits for Disability Cover
It is usually not possible to get immediate cover for the costs related to your disability as the waiting period has to first be passed before your medical aid will consider paying for these costs. This does not apply to any person who was on a medical aid before the disability. In this scenario, most medical aids in South Africa will pay for all the medical costs directly related to the disability. Even if you change over from one medical aid to another, you may not have to wait for this exclusion period to pass.
However, new members of a medical aid who are disabled, with no previous cover, will still have to wait for this exclusion period to pass before the medical aid will pay for any costs relating to the disability as it is seen as a pre-existing condition.
Medical Aid Cover for Disability Surgery
Medical aids may refuse to cover any surgery that could assist with a person’s rehabilitation if they join a medical aid after becoming disabled. This protects the medical aid from bearing huge costs which they may not recoup. For a person who had medical aid cover before the onset of the disability, a medical aid will pay for these types of surgery. However, you should speak to your medical aid as they may not cover new or radical procedures that are not proven to be effective.
It is also important to note that your medical aid will not cover a procedure that is conducted overseas, even if these services are not available in South Africa. You should speak to your medical aid about the extent of cover regarding these types of surgery and the financial implications should your consider undergoing an unapproved procedure. Remember that medical aid is a form of health insurance and the provider will not bear costs that may be ineffective or those of new members who are trying to get cover after suffering with a medical mishap. It is always advisable to get medical aid cover when you are young and healthy, without any pre-existing conditions or disabilities, so as not to be disadvantaged at a later stage.