Many South African medical aid members are unaware that they can only change plans at the year end. While you can leave your medical scheme and join another at anytime, switching plans within the same scheme can only be done in December. Whether you want to move to a higher or lower plan, medical schemes have these rules in place for good reason. However, it often proves frustrating to medical aid members who are ignorant about these otherwise ‘minor’ rules and believe that it is their right to switch plans whenever they wish.

Switching to Higher or Lower Plans

Whether you want more cover at a higher cost or lesser benefits with a cheaper plan, you can only make a switch at the year end. Your medical aid will not listen to your pleas that you cannot afford your current plan and therefore need to switch to a cheaper plan mid-year. Similarly they will not accommodate your wish for a more expensive plan with higher benefits if it is not December. If you intend to switch plans, you need to do it by the year end or wait till next December.

It may seem like a silly rule but schemes have put these measures in place for good reason. It was not always the case in the past. But some medical aid members were switching between plans in a bid to capitalise on the benefits of more expensive plans but not sticking to it throughout the year. In the end schemes were finding that resources were being abused. Remember that more expensive plans have more higher annual benefits as structured according to the higher monthly contributions that are meant to be paid 12 months in the year.

Job Loss and Change In Residence

There are instances where medical schemes may waive these restrictions on changing between plans within a year. For example, if you have lost your job and will definitely not be able to afford your current medical aid plan, then your scheme may be willing to hear you out. Of course, this depends on each scheme – some may, some may not. However, it is in the scheme’s best interest to retain you as a member and assist you in moving to a cheaper plan when life circumstances means you cannot afford your current level of cover.

Similarly your medical scheme will be willing to consider your request mid-year if you no longer qualify to be on a certain scheme due to a change in location. For example, some medical schemes have special plans at a lower priced for South Africans living on the coast. Should the member relocate inland then they no longer qualify for the coastal rate. The scheme may then request proof of residence away from the coast to consider your request to change between plans.

Concessions may be made in the event of death of the main member, divorce leading to an ex-spouse or children needing to switch to another plan on their own and other such life circumstances. Documentary proof will be requested and each case is assessed on its own merit.