Avoiding a Late Joiner Penalty for Medical Aid

April 1, 2018

Most medical aids charge a penalty for joining late. The Medical Schemes Act of 1998 requires medical aids to be open to all. However, medical aids may, by law, impose a late joiner penalty. This protects schemes from members holding off on joining while they are young (and healthy). And then signing up when they are more likely to need care.

The funding model for medical aids is based on the premise that younger (and healthier) members subsidise the claims of older (and potentially sicklier) members. This obviously isn’t always the case but applies in the majority of cases. If everyone waited until later in life to join, then medical aids would go out of business. It would also be unfair for lifelong contributors to compensate for late-joiners.

Late Joiner Penalty

Late joiner penalties apply after the age of 35 and the member pays for the duration of membership. The penalties increase the member contribution by set percentages. And these depend on the number of years an individual hasn’t had South African medical aid cover. These penalties are outlined below:

 

Number of years not covered Maximum Penalty
1 – 4 years Contribution x 0.05
5 – 14 years Contribution x 0.25
15 – 24 years Contribution x 0.5
25+ years Contribution x 0.75

 

Example

Jack is 55 years old and has not been on medical aid since he was 32. He has therefore had no cover for 23 years and falls into the 15-24 years band. If the medical aid plan that he is looking at charges R1500 per month, then he is looking at an additional charge of R1500 x 0.5 (i.e. R750). His contributions will therefore be R2250 per month.

Changing Medical Aids

There is no late-joiner penalty when moving between medical aids, so long as you can prove continuous cover from the age of 35.

This can be tricky, particularly if you’ve been a member of multiple plans and can no longer access membership certificates to provide proof. This applies particularly to closed company plans which are no longer in operation because your previous employer has closed down or been acquired. This can be overcome by signing an affidavit witnessed by a commissioner of oaths. However, if you lie on your affidavit and are caught out, your membership will be cancelled, and you will not be allowed to join again.

 

 

All info was correct at time of publishing