Your Guide to Switching Medical Aid

We all have different needs when it comes to our health and Medical Aid scheme. While you may have been with your current Medical Aid provider for quite some time now, it might be a good idea to review your current plan and ask the right questions such as how its provisions suit your current state of health. 

If you already considered changing your Medical Aid provider, you are not the first person, nor will you be the last, to do so this year. In fact, switching loyalty is a growing trend among South Africans looking to get the best from their insurance or Medical Aid scheme. A recent study conducted by Hippo.co.za has indicated that 60% of South Africans have changed insurers, of whom 51% have done so in the last two years. 

Whether you’re dissatisfied with the service you’re getting from your current provider or have simply found a better Medical Aid scheme that will cost you less money, making the switch can be just as daunting as a trip to the doctor's office.  We asked a few influencers what consumers need to know when making the big switch.

Business Tech on the ‘switching economies’ phenomenon

"The rise of switching economies sees customers comparing and changing companies to find a better customer experience. According to Accenture’s Consumer Driven Innovation Survey, 76% of South African consumers switched service providers in the last year. Consumers reported being most frustrated by recurring problems, long call-hold times and having to deal with multiple customer service agents.

In addition to bad customer service experiences, South African consumers are also likely to switch due to negative reviews from friends and family. The industries hardest hit by switching economies include retail and banking sectors, as well as Internet and Mobile Service Providers.

The research reveals that customers are looking for a personalised, relevant and seamless experience with mobile support systems and a strong social media presence."

You, Baby and I on Medical Aid and pregnancy

"In today’s world everyone needs to look at their expenses and budget accordingly. We all get onto a cost saving drive. With so much information available on the Internet these days, even making the smallest decisions can be time consuming, especially as a mom because you want to make the best decision possible.

Medical Aid is one of life’s essentials, given the state of public healthcare. That being said, we need to ensure that we are not being ripped off. I know of families that have the same benefit for two or seven people. Medical Aid offers amazing individual benefits but the fine print subject them to a family benefit that is ridiculous. Your premiums increase but your benefits do not.

We are, however, fortunate that we can look at all these finer details. Before switching Medical Aid (especially if you are pregnant), I would offer the following advice:

1. Definitely look at the benefits and read the small print. Important questions to consider:

• Does it cover gynaecology visits?
• How many scans are covered?
• What benefits do you get – like discount partners, etc.?
• Do they cover the 4D scan?
• What is included in the hospital package?
• Are there any exclusions?
• Does it cover follow-up visits?

2. Determine whether your pregnancy will be covered.

3. Get it in writing.

4. Ensure that the delivery will be covered. Some Medical Aid schemes agree to this but then only cover the newborn and not the costs related to the mother.

Cancelling your existing Medical Aid when switching

With the rising cost of private healthcare and a high prevalence of chronic and infectious diseases such as diabetes and tuberculosis in South Africa, Medical Aid can help to cover medical expenses and ensure members get better healthcare services.  According to the 2014 General Household Survey conducted by Statistics South Africa, only 18.1% of South Africans currently belong to a Medical Aid scheme. 

When households face financial difficulties, they are often forced to cut back on lifestyle expenses they can no longer afford. Medical Aid, however, should not be considered a luxury as it is vital that we look after our health. Should households find that their budget is becoming tighter each year, they should ideally compare Medical Aid providers and select the one that best suit their needs.

Fortunately, all Medical Aid scheme providers are amenable to clients terminating their existing scheme to join another one. The recommended time to switch is towards the end of the year, ideally at the start of October. While the cancellation process is fairly simple, there may be a general waiting period of up to three months and a condition-specific waiting period of up to 12 months, after which you will be allowed to become a member of another Medical Aid provider. This is in terms of the Medical Schemes Act (Act No. 131 of 1998), which also states that:

"…members who change medical schemes (…), where the former medical scheme had imposed a general or condition-specific waiting period and such waiting period had not expired at the time of termination, the medical scheme to which the person has applied may impose a general or condition-specific waiting period for the unexpired duration of such waiting period imposed by the former medical scheme."

Gina Jacobson, blogger of A Bit of This A Bit of That, explains the cancellation process: 

"Last year we decided to move our family overseas. Moving to another country entails a lot of admin, especially when it comes to cancelling contracts and subscriptions.

My Medical Aid cancellation was actually the easiest of all the things we did. There are a few things you have to do to make cancelling a breeze.

Put your cancellation in writing, either hand delivered (get a receipt for the document) or by email to the customer service department. Some Medical Aids will even accept a telephonic cancellation.

Check the cancellation terms for the amount of notice you need to give. We had to give one month's notice and we made sure we specified the dates clearly in our letter.

Check with the customer service department that you do not owe the Medical Aid scheme any money. You are given the full allotment of your ‘savings’ upfront and only pay it over to them on a monthly basis, but if you cancel before the year is out, you may owe them money.

Cancelling a Medical Aid should be a quick and easy process but customer service is a thankless job and you are not the only person that needs attention. Keep your sense of humour, be polite and if you don’t understand something about the process, ask the representative to explain it so there are no misunderstandings."

In conclusion

There are lots of Medical Aid options out there, but choosing the right one can be tricky. When looking for a new Medical Aid provider to substitute your current one, be careful not to rush into a decision based purely on lower premiums. With online comparison tools such as Hippo co.za's, it is now easy to compare Medical Aid quotes and find the company that offers the best value.