While exploring a different country, you may rely on the built-in travel insurance that forms part of your medical aid. However, what happens when you stay for longer than a typical vacation?
This week Justmoney has a look at what you should do with your medical aid if you decide to move overseas for a period of time.
According to Craig Comrie, principal officer and chief executive at Profmed, certain medical schemes have arrangements with travel insurance cover to provide for short visits of up to 90 days.
“But this will not cover you if you move permanently,” says Comrie.
He explains that if you are immigrating, you will not be able to use your medical scheme because those schemes generally do not pay for overseas medical costs.
“Medical claims from overseas with different currencies and from doctors who are not registered in South Africa will therefore not comply with the schemes’ rules and not be paid,” says Comrie.
Taking a ‘sabbatical’ from your medical scheme
Moving overseas for a brief period does not necessarily mean you have to close your medical scheme account completely.
“If you are going for an extended period, some medical schemes may allow for a ‘sabbatical’ status to remain on the scheme which means when you return you do not have underwriting – otherwise known as a waiting period,” says Comrie.
“This may cost you a nominal amount per month just to keep your membership record active, but it will not allow you to claim until your membership is reactivated,” he adds.
Different options for different durations
If you leave the country for between six months to one year, Comrie recommends keeping your medical scheme current in order to avoid underwriting when you return.
It’s therefore best to find out whether your medical scheme offers a “sabbatical” period and to pay the small monthly amount so that you can pick it up where you left off when you return.
If you intend to move overseas for two to five years, Comrie suggests finding out what kind of cover is available in the country you’re moving to.
“I am aware of people who moved to England thinking that they would have cover with the National Health Service, which is the public health fund for all locals. But this is not a given unless you are a citizen,” says Comrie.
“I would suggest you rather get cover in the country you find yourself in. South African healthcare costs are very reasonable compared to some overseas destinations, so be careful because cover could cost you significantly more or have reduced benefits or deductibles where your first $5,000 (approximately R71,289) comes out of your own pocket,” he explains.
If you intend to move overseas for longer than 5 years, Comrie points out that it’s important to take out equivalent cover so that when you return you can prove this to your previous insurer and avoid late joiner penalties and underwriting.
Impact of Medical Schemes Act
The Medical Schemes Act regulates medical schemes in South Africa, but it can’t stretch outside the country’s borders. However, when you return it allows for late joiner penalties and underwriting.
“This protects the members of the scheme who have been contributing toward the reserves of a scheme over a long period of time from members who have just joined and want to claim,” says Comrie.
“If you have a chronic or medical condition it can be excluded for 12 months, which means the scheme does not need to pay for any claims related to your chronic or medical condition,” he adds.
He recommends being aware of the waiting periods and conditions before you take up membership with any scheme.
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