Select Page

Any member can leave a medical when they wish provided that the submit appropriate notification to the scheme. It is illegal or fraudulent to do so. But if you joined scheme solely to have your pregnancy and labour costs covered and then resign thereafter, it is a question of ethics. Medical schemes are well aware of this trend and for this reason there are waiting periods imposed for maternity benefits. In fact there is a term for this type of behaviour whether it is to cover the cost of pregnancy/childbirth or treatment for other medical conditions. It is known as anti-selective behaviour.

Find cover that suits your budget

How long are you forced to stay on medical aid?

You are not forced to stay on a medical if you do not wish to do so. It is not like having to pay your taxes, contribute towards UIF and other mandatory deductibles. Medical aid is entirely optional. It is not even mandatory for your employer to offer a partial payment towards your medical aid contributions. At no time are you therefore forced to continue with your medical aid membership. However, there are consequences if you need cover and have already given up your medical aid – you will have to foot the medical bills thereafter out of your own pocket.

It is well known that many young women opt not to be on medical aid for a number of reasons. However, once they fall pregnant then then scramble to find cover as soon as possible. Their sole interest is the maternity benefits that that the medical aid offers. Almost every medical scheme in the country has acted against this practice. Pre-existing pregnancy is considered as all other pre-existing conditions and subject to a 12 month waiting period.

GEMS and Pregnant Members

However, the country’s largest medical scheme, GEMS (Government Employee Medical Scheme), does not impose the same waiting period. Pregnant women who are government employees or dependants of a government employee can join the scheme and have the existing pregnancy covered as per the benefits of the plan in question. But even GEMS is aware of this anti-selective behaviour and has requested members to discontinue with this practice. Read more on Help Your Scheme Protect Your Benefits on the GEMS website.

Quit Medical Aid After Childbirth

Denying your pregnancy in the early stages, promising to sign a contract that you will stay on the scheme after the pregnancy, attempting to threaten the scheme with legal action and even laying complaints on public forums like Hello Peter will not get you medical aid cover. Schemes deal with this non-disclosure and threats on a daily basis but the bottom line is that rules are rules. You cannot get medical aid to cover your current pregnancy if you are already pregnant at the time of joining. The only exception is if you are moving from one scheme to another.

There is no comparative alternative to medical aid. Even hospital insurance, aka hospital cash back plans, cannot match the cover as a medical aid and will not be accepted by private hospitals or doctors as a means of compensation. While hospital insurance policies are useful it is not a medical aid or any such alternative. Rather stay on medical aid from early as possible, well before you need it, so that when eventualities like pregnancy do arise, you can rest assured of cover.

Medical schemes have these waiting periods in place in part due to the behaviour of consumers. Many have joined a scheme, utilised benefits immediately for their needs and thereafter quit the cover. It drains resources from the medical aid’s pool and disadvantages other members who pay for medical aid loyally every month even if they do not use the benefit.