Life happens. It ebbs and flows constantly, this we all know, and try as we may to foresee the future by sound financial planning, thrifty spending during the year and always maintaining our financial responsibilities; the only thing any of us can say for sure about the future is that it is completely uncertain.
When it comes to your medical aid cover the same applies. Although we all try to make sure that we are covered for all eventualities, life has a sneaky way of throwing a curveball when we least expect it. When one of these curveballs comes flying your way it can sometimes be very frustrating to find out that you can only change your cover at a certain time of the year. Sure, if you want to move over to a new medical aid provider entirely, then you can make the change any time, but if you want to upgrade or downgrade your cover using the same provider, you have a limited window period in which to make these changes. The frustration associated with not being able to change cover as your needs dictate can be overwhelming, but there are sound reasons for these rules, even if they aren’t always to your liking.
Most of South Africa’s medical aid schemes will only allow you to make changes during a window period in December. There are many reasons why there is only a short window period for change, but the three main ones are:
- Changing schemes during the year may result in amounts owing to the scheme you are leaving, due to advanced savings utilised. By only allowing you to make the change at the end of the year, the scheme can be sure that they aren’t in for any financial losses.
- Unethical misuse of medical funds can occur if a member anticipates that they might need more cover for an expensive treatment in the near future. If members could upgrade and downgrade at any time then it would be quite simple to upgrade your cover if you foresee an expensive procedure in the near future and then simply downgrade again afterwards, once you’ve had the procedure, and so on.
- Unregulated up and downgrading causes financial instability for the fund. Medical aid schemes rely on pre-calculated payments from you in order to cover all members for the eventualities in their unique cover. Should members be able to downgrade at any time, these financial calculations go straight out the window, and that means that the monthly instalments you pay could fluctuate accordingly. By only allowing a small window period, schemes can ensure that your monthly payment stays constant throughout the year, with increases only occurring on renewal each year.
Medical aids WANT you to stick with them, they want your loyalty. Instead of allowing you the opportunity to upgrade or downgrade at any time of the year many of them offer wellness incentives instead. Schemes offer wellness programmes, which are really worth it if you work with them. They aim at rewarding you for being healthy, offering a definite value proposition that could compensate for the cost of your plan. The tricky part is to get involved and keep up with the programme, but if you do this then you should be able to maintain the plan that you are on until the time comes for up or downgrading.
In extreme cases such as cancer treatments, each case is looked at individually and the scheme you are on would have to evaluate accordingly to see if an early upgrade is warranted.
Also note that should you decide to upgrade or downgrade your plan, there will be no NEW waiting periods imposed on your new plan.
If you are in a position where you are thinking of upgrading or downgrading your medical cover, here are 5 important tips to remember:
- You need to be sure about the change.
Study the information on the plans your medical aid offers. Alternatively, contact us to obtain the relevant information. Most funds have a document available where they compare the benefits and premiums of the plans they offer. Study it, make notes and ask questions!
- Understand the plan you’re on and the plan that you’d like to move to.
It sounds obvious, but the first thing you need to do is understand exactly what cover you have on your current health plan. You’d be surprised at how many people don’t read the benefit guides they receive when signing up for a health plan.
- Compare costs
Compare the costs of your existing plan with the new plan that you consider moving to. Your current plan’s contribution will increase in January anyway, so it does not help to compare the new plan’s contribution to the current cost. Ask us for help if it gets confusing.
- Speak to your provider
Check with us how long your request will take and what their cut-off date is for processing it. You want to make sure that you are well within the window period to avoid further frustration.
- Don’t forget to find out about Gap Cover
Most of us think that because we pay monthly fees we are covered in full for all eventualities. Wrong! Finding out afer a catastrophic event such as an accident or unexpected surgical procedure that you are liable for a large portion because of the level of plan that you’re on can be a nasty surprise to say the least. As a rule, if you’re on a higher level plan, the coverage that you get should be higher, but even the very best cover may fall short of high hospital bills. Many specialists are just not willing to accept the medical aid reimbursement rate as full payment, which can lead to large shortfalls which, in turn, become your responsibility. Making sure that you have a great gap cover policy in addition to your medical aid ensures that you are always covered, no matter what the situation. Speak to us to see what would suit you best in this regard.
We understand that deciding on the right medical cover for you and your loved ones, as well as trying to plan for all eventualities can be very daunting and even confusing at times. Reams of documents, rules that are hard to understand and medical aid jargon can often baffle even the most logical minded. That’s what we are here for. We want to speak to you and take the time to assess what you currently need and what your future needs might be, and should the unforeseen happen, we are also here to assist you with communicating with your scheme to find a positive outcome for all.
Speak to us if your medical needs suddenly change – we can’t promise you the world, but we can promise you a trusted resource who understands that life happens.