Warning to South Africans without medical cover

South Africans who delay joining a medical scheme could face late joiner penalties, significantly increasing their monthly medical aid contributions.

Ambledown Financial Services marketing executive Michael Emery warned that waiting too long to join a medical scheme could cost people dearly later in life.

He said South Africans should ideally join a medical scheme as soon as they start working and before they reach age 35.

Emery pointed out that many young South Africans opt not to join a medical scheme because they are currently in good health or because they cannot afford membership. 

However, he warned that neglecting to do so can prove costly as they become older and are at greater risk of illness. 

“Starting early is an investment in the future of your health, and as important as retirement savings,” he said.

“Everyone should have access to quality health care, so as soon as they can afford it, they should invest in cover that offers primary care, diagnostics and hospital treatment.”

“If they wait too long to join a medical scheme, their contributions will be significantly higher because they present a greater risk to the scheme.”

Emery said medical scheme late joiner fees and waiting periods are designed to prevent misuse of the medical scheme system and protect existing medical scheme members.

In other words, these measures are in place to protect the people who have been contributing to the healthcare fund for several years from those who may try to exit and enter the healthcare system as and when they need to. 

“If people join a medical scheme only once they know they will need medical treatment, it presents a greater risk to the scheme and pushes the premiums up artificially,” he said.

In addition, late joiners who have had no cover for many years are at greater risk of having health issues that were not diagnosed or managed adequately for years.

Affordability problems

Emery explained that medical schemes calculate late joiner penalties based on the individual’s age when joining the scheme and the number of years they have not been a member. 

“The penalty is generally a percentage of the base contribution rate, and could add as much as 75% to the monthly medical aid contribution,” he said. 

Emery acknowledged that the high cost of medical scheme contributions is the reason many people only choose to join them later in life.

However, he said numerous entry-level medical schemes and medical insurance products are available in the market. 

While these products may not cover the full cost of specific treatments, they can be augmented by gap cover, an insurance product to cover shortfalls in medical scheme cover.

Emery explained that this is what gap cover is designed for – helping clients pay for hospital treatment where medical charges exceed what medical schemes will pay for. 

He emphasised that gap cover is not the same as medical scheme cover, and is only available for members of medical schemes.

Emery noted that medical inflation is driving up the cost of healthcare beyond the limits of what medical schemes will cover. 

In some cases, medical practitioners charge as much as 400% of the medical scheme rate or more. 

“Gap cover helps clients pay for essential in-hospital and defined out-patient medical treatment that might otherwise cause serious financial hardship for them and their families,” he said.

“Medical bills shouldn’t stand between you and quality care. Having gap cover can ensure that you get the treatment you need – whether it’s cancer care, hospital procedures, or outpatient treatments – without the financial stress.”