How to Switch Medical Schemes

If you are thinking about changing your medical aid, you are not alone. Thousands of South Africans switch schemes each year in the hopes of getting more benefits for less cash, or because they think another medical aid will give better service.

When can you switch medical aids?

The good news is that you can change from one medical aid to another scheme at any time. Simply find out the facts about your new medical aid and follow the correct procedure for signing up in such a way that your cover is unbroken.

Piggy bank with belt tightenHere are some useful tips for switching schemes:

1.    One scheme at a time. Not that it is illegal for anyone to belong to more than one medical scheme at a time. This means you must resign from your current scheme before signing up with another one. However, this does mean that you will spend any time without any medical aid membership at all.

2.    Contact your current provider. To smooth the process you should let your current scheme know that you are planning to resign from the scheme. You might have to supply your resignation in writing. Establish at what date your cover with them will terminate and make sure you set up your new medical aid to begin the day after your current medical aid will end. For example, if your cover ends on 30 September, your new cover should start on 1 October.

3.    Waiting periods. As a general rule you will get full cover from your new medical aid from the first day. One exception is where you have a pre-existing condition or a chronic condition, in which case you might have to wait 3 to 12 months before getting benefits. If this condition is included in the list of Prescribed Minimum Benefits as listed in the Medical Schemes Act then you should get immediate cover. Also if you are pregnant when you join your new medical aid you might not be covered immediately. This is to prevent people from joining a scheme just to draw maternity benefits and then resign just after the birth. Enquire about waiting periods from your new medical aid.

4.    Best benefits. Before making the decision to switch medical schemes be sure that the new scheme is “better” in terms of affordability and medical benefits. Do not be lured by promises of cheap holidays or movie ticket discounts. These are built into the cost of medical aid and have nothing to do with health care.

5.    Criteria for choosing a new scheme. Factors to look at include: specific benefits, waiting periods, level of cover offered, network or non-network, reputation, stability, member service and speedy payment of claims. Price is a factor but it should not be the overriding one. There are several good, affordable plans available at many schemes.

6.    Taking the plunge. The actual switch from one scheme to another is easy. You inform your old scheme that you are resigning. Get their confirmation that they have received notice in writing. Then contact the new scheme to let them know that you want to sign up. They will send along forms for you to complete and sign. Once you have returned these then they should confirm with you that your application has been received and that your cover will start on such-and-such a date.

Don’t stay with a medical aid that gives you a nagging sense of dissatisfaction and uncertainly. Rather switch schemes to get the benefits, security and good service that you are paying out good money for.