There are a number of complex issues that affect medical aid programs and it can be difficult to understand all of the ins and outs. One of the common areas that causes confusion for medical aid members is late joiner penalties. Let’s take a look at Transmed medical aid as an example in order to explain the basics of something that is a feature of the majority of medical aid programs.
What Is A Late Joiner Penalty?
A late joiner penalty is not a one off fee like many people assume, it is a penalty that will be applied to your medical aid payments for the rest of your life. A late joiner penalty is applied when you apply to join a medical aid plan at a certain age. It means that the premiums you pay will be higher than those paid by regular members. The late joiner penalty usually applies to those aged 35 years and over. The penalty is generally between 5% and 7% and is determined by a formula which is outlined in Regulation 13 of the Medical Schemes Act (131 of 1998). The ins and out of the late joiner fee may differ from scheme to scheme, for example with Transmed medical aid the penalty is imposed on applicants over the age of 35 years who have not been a member of a medical scheme since 1 April 2001 without a coverage break exceeding three consecutive months.
Why Do Late Joiner Fees Apply?
If you look at the Transmed medical aid scheme, the members cover a diverse age range from 21 years to 75 years and older. It is pretty logical to consider that the younger members are healthier than the older ones in most cases. The younger members are more likely to be participating in sports and generally leading a healthier life style, which may mean they claim often for sports injuries and preventative benefits. However, older members are more likely to have ongoing health conditions that require regular claims. In short, older members are more demanding than younger members. If a member joins young then by the time they reach an age where they have a greater need for medical care then they will have paid in enough money to cover that additional need. However, if they join at a later stage then they are depending on funds paid in by younger members. If you consider it this way then it is not unreasonable to expect those joining at a later stage to pay a little extra to compensate for the years they have missed!
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