Whether it’s for financial reasons, changing jobs or a change in your medical aid needs, you may need to change medical aids. But what happens to you in the meantime? 

South African’s were left gobsmacked when radio personality and medical doctor, Dr Sindi Van Zyl’s husband shared his family’s recent hardships. While between medical aids, the doctor contracted COVID-19 and has been in hospital since February. Since then her medical bills have grown such that her family could no longer afford to pay. 

The campaign #GiftSindiLife, which coincided with the doctors birthday raised R1.5 million towards the doctor’s medical bills. Fans and people who knew the doctor through Twitter were moved to contribute towards her ever-growing medical bills, but many are worried people wouldn’t be as generous if they found themselves in the same position. 

Here’s what you need to know before you change your medical aid.

Medical aids have a waiting period

Although medical aids are required by the Medical Schemes Act not to discriminate against members based on their medical history or pre-existing conditions, medical aids can charge higher premiums and even impose waiting periods of up to3 months on members to protect both the scheme and members. 

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During this waiting period, members pay their full premiums but can only enjoy limited benefits. 

What is gap cover?

Gap cover is an important consideration. It covers your medical aids shortfall which would ordinarily fall on you to pay in addition to your existing medical aid payments.

Although Gap cover can help you afford medical expenses where your medical aid falls short, gap cover only covers procedures, medicines and medical care that is included in your original medical aid. So medical expenses that are not covered by your medical aid at all will not be covered by your gap cover. 

According to Old Mutual, gap cover is only effective for existing medical aid members so it will not cover your medical expenses while you change medical aid providers or if you do not have medical aid at the time you need medical assistance.

What happens when you are between medical aids?

From the time you cancel your medical aid to the time you join a new scheme you are not covered by any medical aid and become fully responsible for your medical bills. 

According to  Medical Schemes Act, you cannot claim from your previous medical aid, nor can you claim from the medical aid you intend on joining or have joined for the medical expense that occurred before the end of your waiting period.

 

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While All4Women endeavours to ensure health articles are based on scientific research, health articles should not be considered as a replacement for professional medical advice. Should you have concerns related to this content, it is advised that you discuss them with your personal healthcare provider.