Switching Medical Aids in 2024

Changing your medical aid in South Africa isn't as simple as it might seem at first. Did you know that you can't just switch plans within your medical scheme at just any ol' time? There's a time and place for everything, and that includes medical aid switching.

When Can I Change My Medical Aid Plan?

In South Africa, medical aid schemes don't allow you to glow up your plan until the last quarter of the year, with the change officially taking place on 1 January of the new year. One of the main reasons for this is to prevent people from taking advantage of their medical aid schemes.

Here's an example of what we mean. Let's say Harry and Henrietta are expecting their first baby. Henrietta is three months pregnant and it's mid-year-June. Unfortunately, she's on a medical aid plan that doesn't include any maternity benefits. Henrietta can't just switch to a better plan with, say, three scans included, because she'd be getting the benefits of a higher plan even though she's only paying for half a year for it. Her monthly contributions aren't enough to pay for the whole year.

That's not fair to the rest of the members on the medical aid scheme, who would essentially be the ones paying for a portion of the six months of her medical aid.

Can You Downgrade Your Medical Aid Plan?

Yup, in South Africa you can downgrade your medical aid plan at any time of the year. However, be aware that you might lose certain minimum benefits if your new plan doesn't include the same benefits that your current plan had. Your medical aid cover may very well be lower, especially because you're switching to a lower plan. This could also mean less financial cover for major medical expenses, like cancer.

Can You Change Medical Schemes During the Year?

The short answer is, yes, you can change medical aid schemes at any time during the year. However, there's a good chance you'll be subject to waiting periods, such as a three-month general waiting period or condition-specific waiting periods.

Benefits With New Medical Plans

The first thing is the benefits. What kind of medical cover are you getting with the new plan? Is it adequate for your and your family's health needs? Make sure, if you need medication every month that isn't covered by chronic cover that you have a good medical aid savings (MSA) that can cover this for the year.

Medical Aid Price

For many South Africans, the benefits come second to their healthcare costs. Things are tight in our homes we get that, which is why we offer comparison services, so people can hopefully pay less for their stuff every month. But be careful not to get a medical aid plan that doesn't give you the basics you need just because the medical expenses are lower.

Rather consider a network option—most medical aid providers offer them. This can be a more affordable alternative so that you can still get the cover you need without compromising on benefits. Network options offer the same cover and benefits as non-network plans, except you need to use a defined list of healthcare providers stipulated by the scheme if you want to avoid co-payments and penalty fees.

Prescribed Minimum Benefits

There are 271 medical conditions and 26 chronic conditions that all medical schemes have to cover (along with medical emergencies), even if you're only on a hospital plan. However, how much they cover varies from plan to plan and scheme to scheme. Find out how much your new plan will cover for your pre-existing conditions that fall under the PMBs.

Choosing new medical aid cover can be tricky if you're not sure about the laws that govern medical cover in South Africa. Just remember that whenever you change your medical aid, your medical costs and benefits are bound to change as well, so make sure to do your homework before making the switch.

This article is for informational purposes only and should not be construed as financial, legal or medical advice.