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Thebemed Late Joiner Fee

Overall, Thebemed Medical Scheme is a trustworthy and comprehensive medical aid provider. New Members 35 years or older may be subject to late-joiner penalties on Thebemed Medical Aid Plans. The Thebemed Medical Aid Plans start from R522 ZAR per month. Thebemed Medical Scheme has a trust rating of 2.1.

➡️ Penalty Bands (number of years without cover after age 35)	💶 Maximum Penalty
🟥 1 – 4 years	0.05 x monthly contribution
🟧 5 – 14 years	0.25 x monthly contribution
🟨 15 – 24 years	0.50 x monthly contribution
🟩 25+ years	0.75 x monthly contribution

Thebemed Late Joiner Fees – 9 Key Point Quick Overview

Thebemed Late Joiner Fees – What to know before Joining

If you join Thebemed later in life, you may face premium penalties. This applies to people over 35 who did not have medical scheme cover for a certain period. The penalties are as follows:

➡️ Penalty Bands (number of years without cover after age 35)	💶 Maximum Penalty
🟥 1 – 4 years	0.05 x monthly contribution
🟧 5 – 14 years	0.25 x monthly contribution
🟨 15 – 24 years	0.50 x monthly contribution
🟩 25+ years	0.75 x monthly contribution

Furthermore, “Creditable cover” refers to any verifiable medical scheme membership period for the applicant or their dependent, excluding membership as a child dependent, that ended two or more years before the latest membership application. The number of years of creditable cover can be subtracted from the applicant’s current age, or they are dependent on determining the applicable penalty.

Thebemed Waiting Periods

It is common for new medical aid members to have questions about the waiting period. A medical scheme uses a common fund to pay for claims, so waiting periods are fair. Furthermore, the cost of a single claim can easily reach hundreds of thousands.

The following can be noted regarding Thebemed’s waiting periods:

✅ Except for people who have never paid into a medical scheme before or who have had a break in membership of more than 90 days, waiting periods do not apply to life-threatening emergencies or prescribed minimum benefits (PMBs).
✅ In some instances, a new member who joins the plan with a particular pre-existing health condition may be ineligible to file a claim for treatment related to that condition for up to a year.
✅ If a member has belonged to a different medical plan for less than or up to 24 months, they may be subject to a condition-specific waiting period, including for pregnancy, upon joining a new plan.
✅ If the previous membership lasted longer than 24 months and there was no break of at least 90 days, a three-month general waiting period may apply.
✅ Since pregnancy is a PMB, the same rules regarding waiting periods apply.

Waiting periods are implemented to prevent people from joining a health insurance plan only when they have a serious medical emergency and dropping coverage shortly after.

Thebemed Exclusions

The Thebemed exclusions include, but are not limited to, the following:

✅ Cosmetic treatments such as blepharoplasties, genioplasties, rhinoplasties, otoplasties, removal of tattoos, and labial frenectomies for patients over the age of 8 years old are not covered.
✅ Treatment for obesity, including liposuction, tummy tuck, and bariatric surgery, is not covered.
✅ Cosmetic breast reduction and reconstruction, refractive surgery, and human growth hormones are not covered.
✅ Treatment for infertility or artificial insemination is limited to Prescribed Minimum Benefits in State Hospitals.
✅ Thebemed does not cover holidays for recuperative purposes.
✅ Services rendered by persons not registered with a recognized body in South Africa constituted by any law are not covered.
✅ Purchase of medicines and proprietary preparations such as bandages and aids, nutritional/food supplements, acne treatment, toning and slimming products, domestic and biochemical remedies, vitamins (except for prenatal conditions and children under 12 years), aphrodisiacs, all soaps and shampoo (medicated or otherwise), anabolic steroids, contact lenses preparations, medicines and preparations advertised to the public and readily available without prescription are not covered.

and many more.

Thebemed and Pre-existing Conditions

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 Thebemed, 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 vs. Waiting Periods – What is the Difference

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.

What Happens if You Do Not Pay Late Joiner Fees

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.

National Health Insurance (NHI) Bill South Africa

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.

Our Verdict on Thebemed Late Joiner Fees

In conclusion, Thebemed imposes premium penalties on late joiners over 35 based on the number of years without medical scheme cover.

While this may discourage people from joining late, it also raises questions about fairness and affordability for those who may have had financial or other reasons for not joining earlier.

The penalty fees could also affect members’ budgets, making accessing healthcare services harder. Therefore, while Thebemed’s late joiner fees may have good intentions, their impact on members should be carefully considered.

Thebemed Late Joiner Fees Frequently Asked Questions

What are Thebemed Late Joiner Penalties?

Thebemed Late Joiner Penalties are additional fees you may be required to pay if you join Thebemed medical scheme after a certain period has elapsed since you became eligible to join a medical scheme.

How do Thebemed Late Joiner Penalties work?

The penalty amount is calculated as a percentage of the standard monthly contribution, determined by the years since you became eligible to join a medical scheme.

Can I avoid Thebemed Late Joiner Penalties?

Yes, you can avoid Thebemed Late Joiner Penalties by joining a medical scheme before the end of the late joiner penalty period, typically within 12 months of becoming eligible to join a medical scheme.

How do Thebemed Late Joiner Penalties impact my medical scheme membership?

The impact of Thebemed Late Joiner Penalties on your medical scheme membership is that you will have to pay a higher monthly contribution than other members who joined the scheme during the normal period.

Is it worth paying Thebemed Late Joiner Penalties?

The decision to pay Thebemed Late Joiner Penalties ultimately depends on your personal circumstances and financial situation. However, in some cases, paying the penalties and joining the scheme may be more cost-effective than remaining uninsured.

Are there any exceptions to Thebemed Late Joiner Penalties?

Yes, there are exceptions to Thebemed Late Joiner Penalties, such as if you were previously covered under another medical scheme or could not join a medical scheme due to certain circumstances, such as being a dependent of a person who was a member of a medical scheme.

How do I calculate Thebemed Late Joiner Penalties?

The penalty amount is calculated based on a formula considering the years since you became eligible to join a medical scheme and the percentage of the standard monthly contribution that applies each year.

What are the pros and cons of joining Thebemed after the late joiner penalty period?

The pros of joining Thebemed after the late joiner penalty period include access to comprehensive medical cover. In contrast, the cons include the higher monthly contribution and the additional financial burden of paying the late joiner penalties.

How can I manage Thebemed Late Joiner Penalties?

To manage Thebemed Late Joiner Penalties, you can consider joining a medical scheme within the normal period or exploring other options that may offer lower or no late joiner penalties.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.