Under What Circumstances can you be Denied Medical Cover?

There are scarce situations in which you can be denied medical aid cover.

However, many people are under the impression that there are no reasons for you to be refused by a medical aid scheme- but this is not true. Though it is unlikely you will be rejected, there are conditions in which you will be subject to extra payments and fees.

The Difference between Medical Aid and Medical Insurance:

According to the South African legislation insurance falls under the Long/Short Term Insurance Act. Medical aid falls under the Medical Schemes Act.

The law dictates that no one can be denied a medical aid scheme based on their age, gender or pre-existing condition. These factors may also not influence the amount you are charged for medical cover.

Medical Aid Conditions for Fees and Penalties:

Even though you may not be denied medical aid, you may be subject to a late joiner fee. The late joiner fee exists to stop medical aid schemes losing money when people don’t have medical aid while young and healthy.

This prevents people from waiting until they become ill to join a medical aid scheme. The fee can be up to 75% and your cover can be given a waiting period of up to a year.

The Few Situations in which you can be Denied Medical Aid Cover:

• If you are dishonest about your medical condition/s you will be denied cover. You need to be 100% honest about any conditions you have had diagnosed or surgeries you have undergone.

• If you are already pregnant when you apply for a medical aid.

• You are not making your monthly payments.

• If you still belong to another medical aid scheme.

Even if you have a chronic medical condition, they cannot remove you from the medical aid scheme. Medical aid cover may be denied in a handful situations but none of which may include things outside of your control like your health, gender or age.

Knowing more about what cover entails can help you choose the right medical aid scheme for you and your family.