Medical aid exclusion period

[Terence1983]

Read it again: "Does have access to PMBs". They cannot impose a waiting period on PMB cover if unbroken. Normally for pre-existing conditions, a new scheme may apply loading against the premuim to offset the risk of a new member.

No no they cant load a loading on the premium, the loading on the premium is a late joining penalty and it only applies to people over 36 years of age and it works in percentages, 1-5 years on no cover is 5%, 6-15 is a 25% penalty and 16+ is a 50% penalty. Ie. member is 48 years old and has never been on a medical aid before, she will get 48-36=12 years of no cover so she will be loaded with a 25% late joining penalty ontop of her premium.

If they have a break of more than 90 days, they can be given a 3 month waiting period for all conditions and a 12 month condition specific waiting period for the condition, example Asthma or Hypertension and they will not have access to PMB cover. PMB cover will only apply if they were on a previous medical with no break more than 90 days.

Damn feels like im training staff on the medical schemes act again LOL, been a while.

 

[SYNERGY]

Try going through a broker as well...

 

[Kosmik]

No no they cant load a loading on the premium, the loading on the premium is a late joining penalty and it only applies to people over 36 years of age and it works in percentages, 1-5 years on no cover is 5%, 6-15 is a 25% penalty and 16+ is a 50% penalty. Ie. member is 48 years old and has never been on a medical aid before, she will get 48-36=12 years of no cover so she will be loaded with a 25% late joining penalty ontop of her premium.

If they have a break of more than 90 days, they can be given a 3 month waiting period for all conditions and a 12 month condition specific waiting period for the condition, example Asthma or Hypertension and they will not have access to PMB cover. PMB cover will only apply if they were on a previous medical with no break more than 90 days.

Damn feels like im training staff on the medical schemes act again LOL, been a while.

Ah, didn't know that, I thought it applied to people joining with pre-existing conditions as well. My mother and father had loading but they, as you stated, were loaded for not being members anywhere before and late in life. I always thought though that additional loading was done due to them both having pre-existing conditions. Yes, they had the 12 months waiting as well but paid the premium for years. What's interesting though is that after the death of one, they changed medical aids twice and the latest one dropped any loadings so they are actually paying less than when they first started.

Are loadings supposed to carry between medical aids? What's to stop someone from getting rid of loading after 2 years?

 

[Terence1983]

Ah, didn't know that, I thought it applied to people joining with pre-existing conditions as well. My mother and father had loading but they, as you stated, were loaded for not being members anywhere before and late in life. I always thought though that additional loading was done due to them both having pre-existing conditions. Yes, they had the 12 months waiting as well but paid the premium for years. What's interesting though is that after the death of one, they changed medical aids twice and the latest one dropped any loadings so they are actually paying less than when they first started.

Are loadings supposed to carry between medical aids? What's to stop someone from getting rid of loading after 2 years?

Yea it does carry over to the next medical aid when changing and usually lasts for life unless you can provide proof of previous cover and they will recalculate the penalty. If it dropped, it was more than likely due to a special take on concession for that specific scheme. I know some times when a scheme is doing a membership drive, they will be willing to take 'bad risk' members but only under certain conditions and with certain brokers depending on the size of their book with the scheme, brokers move their members around a lot so don't always believe they getting you the best deal, they getting themselves the best commission in the end. Ive worked with a scheme (not mentioning names for security sake) in the past who had an initiative like that.