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Overall, Medshield is a trustworthy and comprehensive medical aid provider. New Members may be subject to late-joiner penalties or a waiting period for pre-existing conditions. The Medshield Medical Aid Plans start from R1584 ZAR per month. Medshield has a trust rating of 4.1.
🟥 Medical Aid | 🔎 Medshield |
đźź§ Waiting Period | Possible |
🟨 Late Joiner Fee | Possible |
đźź© Plans (from) | R1584 ZAR |
🟦 Trust Rating | 4.1 |
When registering with Medshield, new members must disclose details of their previous medical aid and prove such membership and that of their dependents. This information and documents must show the joining and end dates and accompany the Medshield member application.
Furthermore, this will determine whether Medshield will apply waiting periods or late joiner penalties. However, where late joiner penalties have already been imposed, and credible evidence of cover is subsequently provided, the penalty shall be recalculated.
The revised penalty shall be applied beginning the following month.
Often, there is a waiting period for pre-existing conditions. This is to prevent new members from abusing medical insurance for a brief period to finance pricey procedures and cancel their membership shortly after.
According to the Medical Schemes Act No. 131 of 1998, the following waiting periods could apply when joining Medshield:
Finally, a late joiner contribution penalty may apply.
Medshield does not cover some of the following, with a full list available on the official Medshield website:
and many more. A full list of exclusions will be provided by Medshield.
When joining a medical aid scheme, it is essential to note that there is usually a waiting period of 12 months before any pre-existing conditions are covered. Therefore, joining a medical aid scheme earlier in life is advisable, rather than waiting until old age when the risk of developing chronic health conditions is higher.
Additionally, it is important to note that some medical aid schemes, such as Medshield, have specific policies regarding pre-existing conditions.
Therefore, it is important to research and understands the policies of a medical aid scheme before joining to ensure that you are fully aware of any waiting periods or limitations regarding pre-existing conditions.
Late Joiner Fees are a one-time penalty fee charged by medical aid if you join after a certain age or have never been a member of a medical aid program. Waiting periods, on the other hand, are periods during which you are not covered for certain medical aid benefits.
These waiting periods apply to all new members, regardless of whether they are charged Late Joiner Fees. Depending on the benefit, waiting periods can range from three to twelve months.
Your medical aid membership may be suspended or terminated if you fail to pay the Late Joiner Fees. The scheme may also pursue legal action to collect overdue fees. If your membership is suspended, you cannot access medical aid benefits until you have paid any outstanding fees.
If your membership is terminated, you must reapply for membership and may be subject to even higher Late Joiner Fees. Therefore, paying your Late Joiner Fees on time is crucial to prevent interruptions in your medical aid coverage.
In South Africa, the NHI is a proposed universal health coverage system. It is still in the planning stages, but it could affect Late Joiner Fees and other facets of medical aid.
Overall, Medshield implements late joiner penalties to ensure members do not wait until they need medical assistance to join the scheme. The late joiner penalties are designed to encourage individuals to join the scheme when they are younger and healthier, thus balancing the risk pool and maintaining affordable contributions for all members.
Members subject to late joiner penalties must complete the MDS Member Record Amendment and Dependent Registration Form and submit it to Medshield. Medshield will then apply a late joiner penalty based on the information provided, ranging from 5% to 75% of the member’s contribution.
Prospective members must understand that late joiner penalties can significantly impact their contributions, particularly if they have pre-existing conditions or a history of gaps in medical scheme cover.
Members subject to a late joiner penalty might also have to serve waiting periods for certain benefits, such as hospitalization, maternity care, and chronic medication.
To help members estimate the cost of their penalty, Medshield provides a late joiner penalty calculator on their website. The calculator considers the member’s age, length of membership in the medical plan, and any coverage gaps. However, Medshield reserves the right to determine the exact penalty and tailor it to each individual’s circumstances.
Medshield’s late joiner fees can rise if you have a pre-existing condition. In addition, a risk-based penalty may increase the member’s contribution to Medshield.
After paying a Medshield late joiner fee, you must wait for benefits for a different amount of time for each benefit. For example, typical waiting periods for medical care include three months for primary care visits and twelve months for hospital stays.
Penalties for late enrollment in Medshield can be challenged. Members who disagree with a Medshield decision may submit a written request for reconsideration and any relevant supporting materials.
Members of Medshield have differing views on the topic of late joiner fees. Some contributors defend the fees, saying they must cover costs and ensure everyone pays their fair share. Some people argue that the prices are too high, especially for those with health problems. Some members have also reported problems with the late-joiner penalty and benefit waiting periods.
The specific fees and penalties may vary from medical scheme to medical scheme and are often based on the risk pool and the cost of providing benefits.
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