Medical Aid Top-Up Cover

December 3, 2024

We’ve already talked about Medical Aid Top-Up Cover in other posts, but a lot of people still keep asking. Is it worth the monthly payments? The short answer is YES.  Let me give you a couple of examples that I have come across in my career.

Paying the Gap – Medical aid top-up cover

A few years ago, two of my clients, Jim and his wife, were expecting their first child. At the time, they were already well covered by their medical aid scheme. This included the part of his policy that includes 200% in-hospital expenses. Although I had not been able to convince him that gap cover was necessary. There were some reasons for this.  His wife required a caesarian section, and Jim started doing his homework to find out about the financial implications. He got his quotes and consulting with his medical aid. Then came back to me and we took a look at how things stood.

The total cost of the procedure was going to be R11 500. Which his medical scheme even with 200% in-hospital cover, would pay just over R6 400. Jim was shocked that he would have to pay about 44% for a common procedure. At the time, Jim would have been paying as little as R55 a month for gap cover. Which is a lot less than he had to pay out of pocket.

Jim discovered the hard way the importance of top-up cover to make up those unexpected shortfalls. And I learned to try harder to convince my clients of the importance of this kind of insurance!

Paying the Medical Aid Premiums – Medical aid top-up cover

At about the same time, I was helping another couple – Paul and Yvette – to get their medical cover in order. The cover from their Discovery health plan was more than sufficient for their family. Although Paul was not completely certain their cover was enough. His concern was for his family if anything should ever happen to him. At the time they were paying R5 435 each month for their cover.

Paul was afraid if he was no longer there, Yvette would not be able to pay for the medical insurance. This was a real concern because Yvette is a housewife with no income of her own. She would have to pay R 3  039 every month to continue to receive the quality medical care. That medical care for Yvette and her daughter would cost R 36 500 a year.

Paul was worried that she wouldn’t be able to afford it and would have to abandon their scheme, leaving her and Sally in trouble if they ever required medical attention. And, as I pointed out to Paul, even if Yvette were to get a job and join a medical aid again at a later stage, there would be penalties involved because of her age.

Medical aids charge higher rates for members who join after age 35!

We examined the alternatives and eventually agreed that his best option was a Turnberry Premium-Care top-up package. For a negligible amount each month, Premium-Care continues to pay both your medical aid and Turnberry contributions for up to two years after the death of the primary member.

Looking at the figures, Paul would pay just R1 416 per year to cover more than R36 000 worth of medical aid payments, if the worst ever happened. Paul didn’t hesitate. He took the Premium-Care policy about five years ago, and although Yvette has thankfully never had to use it, he recently told me that he doesn’t regret a single cent of what he has spent.

Understanding the Waiting Period and Disclosure – Medical aid top-up cover

By now I hope that you are beginning to understand the importance of top-up cover, and how it can help you with any number of unforeseen situations. However there are a few things you should be aware of, and one of these is the waiting period. Most medical aid and top-up plans have a waiting period that must pass before you can claim your cover. Normally this is three months, but in the case of pregnancy and certain other conditions, it can be nine months or longer.

I was approach quite recently by one of my clients asking to explain this. The waiting period exists to prevent people from taking advantage of the benefits offered by a good medical aid or top-up plan. Some people have tried to join a scheme, claim the benefits immediately, and then leave as soon as they are healthy. That’s hardly fair to established members, who will in effect be subsidising these fraudsters!

This leads us to the importance of disclosure. Whenever you join a medical plan, they expect you to make certain disclosures about your state of health – whether you are pregnant, or suffering from any illness, for example. My advice is: be honest. Non-disclosure of relevant medical conditions will result in your claim being rejected.

Top-Up or Not?

So, to answer the question I posed at the beginning of this post: Yes, buy a medical aid top-up cover, and do it as soon as possible so that you can get the most from your investment. Contact one of our consultants, and very soon you could have cover against whatever your medical future may have in store for you.

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All info was correct at time of publishing