YOUR MONEY: Shopping around for medical aid

Question:

Last week a reader wrote: it’s time to adjust my medical aid — is there any place I can go to that compares all the options across all medical aids? Also: why can’t I downgrade (or upgrade) at any time?

Answer:

To compare medical aid options across all providers in South Africa, you can use online comparison platforms and tools specifically designed for this purpose. Some popular websites include:

• Hippo.co.za: this platform allows you to compare various insurance products, including medical aid, in the country;
• Medical Aid Search: this website is dedicated to helping users compare different South African medical aid plans; and
• Discovery Health: its website provides a comprehensive tool to compare different medical aid plans, not just its own offerings.

It is, however, a good idea to seek independent advice from a financial adviser who specialises in health care. Not only will they be able to compare different medical aid plans from various providers, they’ll also assist you in choosing the best plan from your current medical aid provider, based on your specific health-care needs and level of affordability.

It is very important to note that changing from one medical aid scheme to another may result in underwriting, or conditions, being imposed on your membership.

• The Medical Schemes Act specifies that a medical scheme can impose a three-month general waiting period, a 12-month pre-existing exclusion or a late joiner penalty upon joining, or these in combination, depending on your underwriting category.
• People’s health risk status and previous medical scheme membership history determine which underwriting category they fall into.

When it comes to downgrading your medical aid plan, the ability to do so may depend on the terms and conditions of your medical aid scheme. Generally, these schemes have certain rules and regulations regarding when and how you can change your plan. It’s essential to check the specific terms of your scheme to understand the rules governing downgrades.

Here are some common reasons why immediate downgrades might not be allowed: 

• Waiting periods: some medical aid plans have waiting periods before you can make changes, particularly downgrades.
• Annual review periods: many medical aid schemes have specific periods during the year when members can make changes to their plans. This is often during an annual review period.
• Policy terms and conditions: the terms and conditions of your specific medical aid policy will outline the rules regarding plan changes. Some plans may require you to stay on a particular option for a minimum period before making changes.

Why you need to review your medical aid plan before January of each year:

Plan changes allowed:

• The act states that people belonging to a registered medical scheme must be allowed to change their plan on January 1 of every year.
• It’s important for the medical scheme to protect itself, including against the possibility of antiselection, which can occur when members are allowed to upgrade at any time of the year. Generally members only do so when they need extra cover, which is seen as antiselective. This poses a huge risk to the medical scheme.

Yolandi Hickman and Elke Brink, PSG Wealth R21, Stellenbosch   

We want to hear from you! Send questions to yourmoney@fm.co.za