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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!
With Nampack medical aid, members and their beneficiaries are able to access a number of benefits designed to assist in the treatment and management of HIV and AIDS. These benefits can be accessed by registering on the Your Life HIV Management Program, which is administered by Momentum Medical Scheme.
Nampack medical aid are dedicated to the ethos that HIV sufferers should be able to live a normal and productive life wherever possible. They believe that discrimination and misunderstanding through ignorance is not acceptable. In today’s modern society we have access to advanced medical care which means that both HIV and AIDS are now considered to be a manageable chronic disease instead of the death sentence that it once was. With the Your Life management program Nampack medical aid members will have the support they need to remain healthy, something that is especially important for HIV/AIDS sufferers due to their lower immune systems.
The benefits offered by the Your Life program are designed to address total wellness, not just the HIV virus. AIDS and HIV manifest differently in different patients meaning that all patients registered on the program have their own specific needs. When registering on the program each member is allocated a dedicated consultant who will create a management program within your allocated budget.
Post Exposure Treatment Benefits
Members can access advice and recommended antiretroviral treatments which are intended to prevent infection by the HIV virus in the case of accidental exposure. This has to be done within two to six hours of the exposure to the virus for the best treatment results. An HIV diagnosis can be devastating and it brings with it many emotions and social burdens. Staff involved with the program are trained to a very high standard and are fully experienced in these issues. Members will be given support every step of the way in overcoming your fears. The main goal is to help members of the program to learn how they can live a positive and more importantly healthy life even after contracting HIV or AIDS.
Confidentiality Guaranteed
Nampack medical aid reassure their members that confidentiality is of the utmost importance. They state that anyone who has the courage to disclose that they have a condition like HIV or AIDS deserves only respect and all staff will offer this to those members. Your condition will be disclosed only to your medical team so there is no need to be concerned that other people, including your employer, would ever learn of your condition.
When it comes to securing access to health care, most South Africans just want a medical aid scheme which is straightforward and easy for them to understand. That is exactly what Hosmed medical aid strive to offer to their members. This particular medical aid scheme is available to both the private and public sectors in South Africa. The Hosmed medical aid scheme was first established in the late eighties with the goal of securing health care for civil employees, but it has now grown at a steady rate and now boasts around 34,000 members.
The key thing that most people look for in a medical aid program is a good selection of benefits at an affordable rate. There are three main plans offered by Hosmed medical aid all of which certainly offer a great combination of benefits that do not carry exorbitant premiums.
The Hosmed Step Option
The basic level of medical aid offered to the public is the Step Option which offers admission to any state run medical facility including hospitals, clinics and treatment centres. These admissions do need to be backed with a pre-authorisation slip. The plan also offers a number of high risk benefits including coverage for chronic illness that does not exclude HIV and AIDS. This is something that many other schemes charge a surcharge for, although the Hosmed medical aid do pace several protocols on this cover. However, HIV management cases will only be approved if the patient is a member of the scheme prior to treatment beginning.
The Hosmed Value Option
If the step plan does not seem the right fit, then the mid level plan may be a better option. The Hosmed Value Option offers most of the same benefits that the Step Option does, but one of the main additions is that this particular scheme option offers a very attractive day to day option which covers over the counter medication with a limit of R500 per family or R120 per prescription. Additional cover offered also includes treatment for mental health issues, physiotherapy and alternative therapies.
The Hosmed Plus Option
At the top level of the scale, Hosmed medical aid offer the Plus Option plan. This is the most fully comprehensive plan offered by the scheme. The over the counter medication usage limits are higher with an annual family limit of R850 and a per prescription maximum of R180. The plan also includes cover for prescription medication. There are also some increases in the day to day benefits.
The important thing to keep in mind if you feel that Hosmed medical aid is an appropriate choice for you is that you need to decide what your needs are prior to choosing a plan. This means taking a closer look at the benefits offered and also at the general health of you and your family members.
We often think of medical aid as just an everyday part of our lives, something that has always been around, but few of us know the history behind it. Medical aid was introduced in America in the 1950’s and did not make its way to South Africa until the 1980’s. Some of the very first medical aid programs that were offered were hospital cash back schemes which are still sold in countries all over the world today. The popularity of medical aid really exploded in South Africa once it had arrived here and by 1989 there had already been over 50,000 policies sold. This figure continued to rise throughout the 1990’s, largely through direct marketing campaigns and advertising in the media.
Main Building of Groote Schuur Hospital – Cape Town (South Africa) (Photo credit: Wikipedia)
In the beginning, the only policies that were available were sold on a group basis. It was not until the start of the 1990’s that individual medical aid schemes became widely available. There were around 13 different medical aid providers across South Africa by 1991. It was in South Africa that so called ‘dread disease cover’, which includes 36 critical illnesses including cancer, stroke, organ transplant and other conditions with a major impact on daily life, first began here in South Africa. This cover is now offered worldwide. Following the dread disease cover, came disability cover, and by the mid 1990’s medical aid was beginning to resemble what we know today.
Statistics suggest that by around 1994 the annual premiums for dread disease and disability coverage had reached over R21 million policies, suggesting that most of the population was signing up for medical aid in order to safeguard against unforeseen medical problems in the future. Within the next five years this had increased to R53 million.
Moving into the present day, medical aid providers cover a wide range of health issues and offer multiple policies allowing everyone to find cover that is suitable for their family’s individual needs. This includes special medical aid programs for those suffering from AIDS or HIV. This is particularly important since in South Africa we have one of the highest rates of HIV infection.
The key thing to remember is that medical aid is constantly evolving, so even if you have found it difficult to get appropriate medical care in the past, there may now be a suitable product for your situation. If you are looking for medical aid quotes, then here at medical-aid.co.za we can compare a number of different providers for you saving you a great deal of time and effort. We will check policies with all of the South African providers to make sure that you are getting the best possible deal.
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.
