Medical Aid Question

[tin4444]

Hi everyone,

Been a longtime reader on the forum, but this is my first question and post.

Due to a change in circumstances over the last few months and some financial pressures, i was looking into going onto a lower medical aid option.
The current plan I am on and the one I was looking at doesnt differ to much but will save me R500 a month.

So I sent the medical aid an email and queried what they would need from me in order to change to the lower option, forms ect, when they replied I can only change my options in December for the following year. Is that true and correct?

I understand increasing my cover might sound suspect to them but decreasing it, why would that be an issue( besides them getting less from my premium).

I can still manage the current premium with a squeeze but was thinking also if my or anyones circumstances changed drastically would I have to cancel my cover and reapply on the lower option in order to do this during the year? Just doesnt sound right.

TIA.

 

[sal12344]

That's Discovery Health I presume. Its in their T&C's. Do you have a broker? Maybe he can motivate it. They can't stop you cancelling though. Threaten them with that if they are difficult about it.

 

[Jings]

Cancelling cover and reapplying on the lower option may be a catch-22 as they could impose a 3 month waiting period (exept for PMB) since the move would be considered voluntary.

The best bet is to speak to your broker for some advice.

 

[R13...]

Interesting it never occurred to me that pmb are exempt from the mandatory waiting period. OP, did you take the medical with an employer or privately

 

[TheRidDlerX]

I am with Medihelp and i know i can only swap packages once a year - dont know if that helps but from what i gathered its pretty fixed that way.

 

[Alton Turner Blackwood]

Well to cover your arse pay the account and then sort out your ITC/Credit bureau states which I'm fairly certain has been dealt a blow with this issue.

 

[tin4444]

No, not Discovery, Bonitas. But suppose they all have it then as T & Cs. Isn't through a broker or employer, personal capacity.

If they do impose the 3 month waiting period it might just be best to wait for November and change then. Perhaps the threat of changing medical aids will work.

 

[bromster]

Discovery only lets you change once per year as well. I changed from Classic Saver to Classic Saver Delta last year, which is the same thing, but with fewer hospitals. The Delta hospitals are my closest anyway, so I am saving R650 or so every month which I keep in my bank for day to day care when my savings run out.

 

[Hosehead]

Discovery only lets you change once per year as well. I changed from Classic Saver to Classic Saver Delta last year, which is the same thing, but with fewer hospitals. The Delta hospitals are my closest anyway, so I am saving R650 or so every month which I keep in my bank for day to day care when my savings run out.

I did the same but on a higher Plan and Delta was for the same reasons - closer to home anyway. It's all fine until you need an operation or procedure from a specialist that doesn't practice at your local Delta or any Delta designated hospital then you have to pay a penalty of R5000 to use the out of Delta Hospital. Happened to me not long ago and I managed to convince the specialist to get operating priviledges at the local Delta and he finally did. But boy, the Standards of care at that Delta Hospital had literally gone down the tubes- one of our finest hospitals once - run by Nursing Sisters and now run by nursing aides- the newly trained ones and you might as well be in a State hospital. I knew there was a catch with Delta. So moral of the story is that your "savings " can be wiped out by penalty fees in one fell swoop if you luck out and need a non Delta specialist and admission to a non delta hospital. They don't make any exceptions either.

 

[bromster]

Urgh. Nothing in this world comes for free. Thanks for the heads-up. My understanding was that if you needed a procedure and it was not covered under the delta network, you ask them for special dispensation. I don't see how they can call it Classic Saver if it does not offer all of the Classic Saver benefits. Surely the delta network must provide for all possible procedures? But I hear what you say about the standard of care. Maybe the delta plan only has a neurosurgeon at a really dodgy hospital, then you're screwed.

Let's hope that my savings offset this 5k payment if needed. Thanks again.

 

[Kosmik]

That's Discovery Health I presume. Its in their T&C's. Do you have a broker? Maybe he can motivate it. They can't stop you cancelling though. Threaten them with that if they are difficult about it.

Actually thats not quite correct ( for Discovery ). There is a normal once a year process but you are able to downgrade/upgrade ( can't remember which but I think it's downgrade ) anytime.

 

[Hosehead]

Actually thats not quite correct ( for Discovery ). There is a normal once a year process but you are able to downgrade/upgrade ( can't remember which but I think it's downgrade ) anytime.

Yeah you can downgrade Disco anytime BUT they are a cleaver sneaky lot and you'll be hit with some penalty you nor your broker never thought existed. They may require reimbursement of the Medical Savings of the higher plan or some such. (just as an example) There's always a catch for everything with them. But for all their faults I prefer them for their more generous benefits compared to other schemes.

 

[hellfire]

That's Discovery Health I presume. Its in their T&C's. Do you have a broker? Maybe he can motivate it. They can't stop you cancelling though. Threaten them with that if they are difficult about it.

Discovery lets you downgrade at any stage (with some Ts and Cs). It's an upgrade that is restricted to once a year.

No, not Discovery, Bonitas. But suppose they all have it then as T & Cs. Isn't through a broker or employer, personal capacity.

If they do impose the 3 month waiting period it might just be best to wait for November and change then. Perhaps the threat of changing medical aids will work.

The changing medical aids threat won't necessarily work as, unless you are in perfect health (and haven't had any claims in the last 12-36 months), another medical aid may not take you without imposing waiting periods.

Urgh. Nothing in this world comes for free. Thanks for the heads-up. My understanding was that if you needed a procedure and it was not covered under the delta network, you ask them for special dispensation. I don't see how they can call it Classic Saver if it does not offer all of the Classic Saver benefits. Surely the delta network must provide for all possible procedures? But I hear what you say about the standard of care. Maybe the delta plan only has a neurosurgeon at a really dodgy hospital, then you're screwed.

Let's hope that my savings offset this 5k payment if needed. Thanks again.

It's not necessarily that the hospital doesn't provide for the procedure. Rather, the specialist you are seeing doesn't operate from that hospital.

 

[Hosehead]

It's not necessarily that the hospital doesn't provide for the procedure. Rather, the specialist you are seeing doesn't operate from that hospital.

And the Specialist won't apply for permissions to operate from that hospital (they will- if you ask them and they will try and accommodate) if the Hospital doesn't stock the Equipment needed for his specialty in the OR so it's really back to whether the hospital can provide for the procedure.

 

[killadoob]

I am leaving discovery, what they offer for 1k a month is a load of crap.

Going to try sanlam, 500 rand less which covers my gym but the benefits are so much more than the hospital plan i on am. Includes doctors, dentist and so on. Discovery hospital plans cover virtually nothing other than hospital, makes sense i know but for 579 i can get doctors visits, once a year teeth cleaning etc. So for the same money i am going to be better off plus it includes death cover of 10-15k.

I was shocked to hear that virgin charge 500 bucks for a one area and 650 for all of them. Still the other 600 bucks is going towards a medical plan where doctor trips are covered, dentistry etc. It's called affinity by sanlam. If you guys want more info you are welcome to pm, i am not selling anything but check out affinity, underwritten by sanlam. One month grace period, not so bad. For a hospital plan with affinity 279.00 and it still covers more than discovery .

 

[ToxicBunny]

That sounds like Medical Insurance rather than Medical Aid?

 

[Goliath]

Get a basic medical aid + gap cover if really financially struggling.. personally I feel there 2 things you don't skimp on, insurance and medical aid!

 

[killadoob]

Get a basic medical aid + gap cover if really financially struggling.. personally I feel there 2 things you don't skimp on, insurance and medical aid!

Really depends on your situation. I regret having medical aid for the last 12 years, so much money i have never used a cent of it. Granted murphies law would go something along the lines of needing it when i didn't have it so it's a tough one but medical aid cover is so expensive. Medical insurance or even as you mentioned gap cover may be better, obviously depending on the person.

Medical insurance would have been so much cheaper, granted it is not something that was around a few years back unless i missed it and it has always been around, only recently heard of all these medical insurance companies popping up.

 

[ToxicBunny]

Its been around for a few years (3 or 4 at least), but it is only now starting to gain traction purely because it is so much cheaper.

I'm in the same boat... I've been paying for Medical Aid (Hospital Cover) for the last 13 years at least, spent easily R60k on it so far, and never had to use it yet.

 

[tin4444]

Thanks for all the replies. I was hoping Bonitas would also allow the downgrade choice at least once a year. But seeing as they don't, will proably vasbyt till November when I can change.

Changing medical aids and/or cancelling my current option and re applying on the lower option only to have a waiting period will probably anyway take me to August/September.

I agree medical aid is not something to be skimped on but at the rate % these annual increases are, salary increases are just not keeping up, if you are lucky to get a salary increase. But that is a whole new and different topic.