While visiting another country, you may rely on the in-built travel insurance that forms part of your medical aid. However, what happens if you stay for longer than you would on a typical vacation?
We take a look at what you should do about your medical aid cover if you decide to move overseas, either permanently, or for a period of time.
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How long will you be covered by your medical aid when leaving South Africa?
According to Craig Comrie, principal officer and chief executive at Profmed, certain medical schemes have arrangements with travel insurers to provide cover for visits of up to 90 days.
“But this will not cover you if you move permanently,” says Comrie.
He explains that if you are emigrating, you will not be able to use your medical scheme because those schemes generally don’t pay for overseas medical costs.
“Overseas medical claims in different currencies, and from doctors who aren’t registered in South Africa, will not comply with the schemes’ rules and will therefore not be paid,” Comrie says.
Taking a ‘sabbatical’ from your medical scheme
Moving overseas for a brief period, however, doesn’t necessarily mean you have to terminate your medical scheme completely.
“If you’re going for an extended period, some medical schemes may allow for a ‘sabbatical’ status for you to remain on the scheme, which means when you return you don’t have to go through the underwriting process again, otherwise known as a waiting period,” says Comrie.
“It may cost you a nominal amount per month to keep your membership record active, but it will not allow you to claim until your membership is reactivated,” he says.
Different options for different durations
If you intend to move overseas for two years upwards, however, Comrie suggests finding out what kind of cover is available in the country you’re moving to.
“I’m 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 locals. But this isn’t a given unless you’re a citizen,” says Comrie.
“I’d suggest you obtain cover in the country in which you find yourself. South African healthcare costs are very reasonable compared to some overseas destinations, so be aware that cover could cost you significantly more. Reduced benefits or deductibles could also apply, where your first $5,000 (approximately R76,890) comes out of your own pocket,” he says.
If you intend to move overseas for longer than five years, Comrie points out that it’s important to take out equivalent cover so that when you return you can prove this to your former insurer and avoid late joiner penalties and underwriting.
Impact of the Medical Schemes Act
The Medical Schemes Act regulates medical schemes in South Africa, and while it doesn’t stretch outside the country’s borders, when you return it does allow 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.