When joining a medical aid, it’s easy to be intimidated by what seems like an endless list of questions. These can range from when you last underwent an operation to whether or not you’re taking any medication. But why so many questions, and so specific?
It is actually quite important, and you want to be 100% honest and thorough when completing these. Ideally, you would want your broker (also known as healthcare adviser) to be present. That way he/she can explain terms you may not understand, or help ensure that you don’t leave something out that you may consider irrelevant.
Why is it important? Firstly, because if you do not correctly and fully disclose your medical history, your claims may be rejected. In fact, you may also get kicked off the medical aid, and may even face fraud charges. Secondly, as you may well know, medical aid members share the same pool of funds. In other words, your contributions go into a savings bank from which all claims need to be paid. Therefore, it is important to avoid a situation where a person waits until they get sick, joins a medical aid and immediately claims for an expensive operation. That would mean that those members who have been contributing monthly, without claiming, have to pay for this new member’s healthcare expenses, without the new member having contributed to the pool.
Based on the disclosure of things like existing medical conditions, medical aid schemes can protect existing members’ funds from abuse by new members, through waiting periods and late joiner penalties. And, as a new member joining, you may be better placed to understand which option you should be joining, once you have completed the questions on the application form.
Can a medical aid refuse to accept you as a member if you do have an existing illness? Nope! South Africa’s strictly controlled medical aid industry is very serious about making sure that despite your age or medical history, you are able to take out healthcare cover and start contributing to a pool of funds which can protect you against future medical expenses.