There is no denying that medical aid premiums are pricey in South Africa and not everybody can afford it. Even existing medical aid members question their level of medical aid cover at times, especially during financially difficult periods. If you have decided to downgrade your cover from a full medical aid (comprehensive cover) with day-to-day benefits, then you should consider your decision carefully before you switch to a hospital plan.

Pros Of A Hospital Plan Medical Aid

The fact of the matter is that a medical aid hospital plan is less cover than a comprehensive medical aid. But this does not necessarily mean that it is inferior cover. A higher cover hospital plan may offer more benefits that your current lower plan full medical aid but only when it comes to the in-hospital benefits and chronic cover. At the end of the day a full medical aid offers you something that a hospital plan does not – limited cover for out-of-hospital day-to-day medical expenses like consultations, medication, other treatments, tests and scans on an outpatient basis.

But you pay for what you get and a full medical aid is the more expensive option when you compares it in-hospital benefit with an equivalent medical aid hospital plan only. If money is tight then you should not give you your medical aid altogether. Switch to a lower plan or even opt for a cheaper hospital plan alone. It is better to have lesser cover than no cover. And with private hospital care in South Africa being so expensive, a medical aid hospital plan is what you need at the very least.

Changing Plans Mid-Year

Most medical schemes will not allow you to change your plan mid-year. This means you cannot move from one plan on the medical aid to another plan, irrespective of whether you are upgrading or downgrading. You will have to wait until the end of the year to make the switch. However, you can resign from your existing medical scheme and join another scheme. Be cautious about doing this as any break in cover many mean that you do not have the protection of medical aid.

But if you cannot wait till the end of the year due to financial constraints, then speak to your medical aid immediately. The fact you are reaching a point where you can no longer pay your medical aid premiums may not necessary mean that they will circumvent their policies. But rather discuss the issue with them. Explain your circumstances. And if no agreement can be reached then switch to a cheaper plan on another medical aid. But do it with your existing medical aid informed, or the change over can lead an interruption of cover.

Switching To Another Medical Aid

If you have to change from one scheme to another, then do it very carefully. As an existing medical aid member, you will be able to bypass the usual waiting periods when you switch to a new scheme. But only if your cover from one medical aid to another is not interrupted. First find the medical aid plan that suits you. There is no major concern if you are switching plans in the same scheme. But if you are changing your medical aid provider altogether then the transition must be handles with great care.

Iron out the details with your new scheme. Make sure you understand the pricing structure and any implications of changing over. Complete the membership forms and wait for approval. You need to inform your new scheme of your existing medical aid membership. While medical schemes do communicate with each other, never leave it to staff. Rather inform you existing medical aid that you will be switching over and provide them with details of your new medical scheme.

It is not always a smooth transition. Sometimes you are billed by your old medical aid despite being a member of the new medical aid. But worry more about continuity of your cover. It should not be interrupted at all. And do not try to keep cover on both medical aids at the same time. It is illegal to belong to two medical aids in South African at the same time.

Leave a Reply

Your email address will not be published. Required fields are marked *