One of the cold facts of a breakup is that if you were on your partner’s medical aid, your ex can have you removed when the relationship dissolves.
Justmoney spoke to insurance industry experts to gain insight into what to do if your ex removes you from his or her medical aid plan.
Importance of following the correct procedure
Unfortunately, it is fully within a main member’s rights to remove a dependent at any time, says Adam Helper, Discovery financial advisor.
“Health insurance is heavily legislated in South Africa. While it is different to other insurance products, one can understand that if the owner of the membership, or the main member, makes changes, the dependent doesn’t have any say in the matter, married or not,” says Helper.
For example, if the policyholder of a car insurance product decides to delete a vehicle from the policy, there is nothing much the primary driver of the car can do other than arrange new insurance.
However, there is a procedure that must be adhered to.
“Divorce can see two people being governed by emotion and forgetting about process. It is important to remember what the correct procedure is to follow,” states Heidi Kruger, an independent medical insurance expert.
The first thing to do, after notifying the dependent, is for the main member to inform the scheme. Most schemes require a notice period that is typically actioned once the main member fills in a termination of membership form.
According to Helper, the notice period for healthcare cancellations or deletions is usually a full calendar month.
Avoiding a gap in your cover
As the dependent, it’s vital to request a membership certificate from your scheme during this period.
“This certificate indicates how long you've been a member for and is important when applying to another scheme for membership,” Kruger adds.
Failure to produce this certificate could see you having to fork out extra money.
“If you are over 35 and can prove that you have been a member of another scheme directly preceding the time of joining the new scheme, the late joiner penalties will not apply,” says Helper.
“Conversely, with waiting periods, even if you can prove that you have been a member of a medical scheme for a certain period directly preceding joining the new scheme, then waiting periods may still apply,” he adds.
Another key consideration is to ensure that there is no gap in your cover as this could further result in the implementation of waiting periods. This means that as the dependent it is in your best interest to apply for new cover within that notice month.
“Medical aids do not want to see a break in cover, and it is especially not in your best interest as the new joiner. If there is a break in cover, this is when full underwriting would apply which often includes a three-month general waiting period, and sometimes a 12-month condition specific waiting period,” Helper explains.
If you are a healthy individual this may not affect you as gravely. But if you have a pre-existing condition, are a heavy smoker, or are over 45, you may find yourself in a financial bind. This is because a waiting period signals not being able to claim, so any medical expenses incurred during that time will need to come out of your pocket.
A win for you as the dependent is that your claims will be covered up until the last day of coverage.
“Most schemes will accept claims incurred while you were a member for up to three months after you have left,” Kruger adds.
The following are a few key things to remember, says Helper:
- Make sure you understand the different elements of cover on your membership.
- Consider plans which cover day-to-day or out-of-hospital expenses. These are designed to assist members in using their own medical savings within the policy.
- Use the online platforms available to all members whether you’re a dependent or main member.
- Try and use service providers who charge medical-aid rates.
Your health should be a priority regardless of the circumstance. Protect yourself today by applying for medical aid cover through Justmoney.