SOUTH AFRICAN MEDICAL AID – UNDERSTANDING WAITING PERIODS AND MANAGING EXPECTATIONS

Whether you are a South African medical aid or medical insurance policyholder, there is no escaping the reality of waiting periods which place restrictions on your ability to claim. Waiting Periods have been around since the dawn of the insurance industry and are too often overlooked when deciding on the most suitable medical aid policy for your family. With a better understanding of these individual waiting periods, you can not only make an informed decision on what medical cover to take out, but also avoid any nasty shocks should you need to submit a claim during the early inception of your medical cover policy. It’s imperative you know beforehand what you are signing up for – the detail is in fine print!

Knowing your Waiting Periods before you sign on the dotted line.

Waiting Periods in the South African medical aid and health insurance marketplace are defined as “the periods of time which must pass before some of all of your health benefits can take effect” (Source)

When considering a policy, the first aspect you should look at is the Initial Waiting Period – the period of time which must lapse before any claim can be submitted (with the exception of accident cases). This can vary from 1 to 3 calendar months, depending on the medical aid provider’s Ts and Cs. Following initial restrictions, Pre-Existing Condition Waiting Periods will remain. These vary by condition and in essence mean that coverage for specific conditions will only kick in after a specified time frame has passed after signing up on a medical aid policy.

Waiting Period Time frames for Day 1 Health Stated Benefit Plans

Initial Waiting Period – 1 Calendar Month (most primary healthcare benefits)

Pre-Existing Chronic Conditions 12 Calendar Months

Maternity Benefit 3 Calendar Months   (Maternity Benefit limited to R20,000)

Optometry/Dentist Benefits 12 Calendar Months

Don’t Wait to find out when it’s too late!

No matter what South African medical aid companies tell you, or how many zeros are advertised in the range of benefits elegantly broadcasted on tv, radio, and digital, waiting periods are the reality which you have to factor in, when signing up for health cover. Treat the contract of a medical aid or health care policy just as you would a cellphone contract or home bond. Day 1 Health has one of the most generous waiting period concessions of any healthcare provider in RSA. Offering a range of Stated Benefit Plans, a comprehensive list of the most important elements of medical cover is explained and answered on their Frequently Asked Questions page.

Make sure you know what you’re covered for, but more importantly, when each coverage type kicks in. Make an informed choice and Apply Online Today.

SOUTH AFRICAN HOSPITAL PLANS – THE IMPACT OF WAITING PERIODS

If you are on any form of medical aid or medical insurance product, there are waiting periods  built into your policy which will restrict your ability to claim from your South African hospital plans for certain periods of time. Waiting Periods have been around since the dawn of the insurance industry and are too often overlooked when deciding on the most suitable hospital plan for your family.

It’s vital you know where you stand when taking out cover. Understanding waiting periods better ensures that you’re not on the receiving end of a nasty shock during the early days of your hospital plan. Know what you’re signing up for in advance. Read on as we unravel the essentials.

Know your various Waiting Period Restrictions before you sign up

Waiting Periods in the medical aid and health insurance marketplace are defined as “the periods of time which must pass before some, or all of your health benefits can take effect” (Source) When assessing which South African hospital plans are right for you and your family, firstly take into account what the general waiting period of the policy is – ie the initial period of time that must pass from when you sign up, until you can legitimately claim for hospitalization benefits. It usually varies between 1 and 3 calendar months depending on the provider. The exception to this exclusion is Accident or Trauma Benefit, which has immediate cover. Pre-Existing Conditions are also tied into a hospital plan policy with exclusions normally enforced for the first 12 months of the policy.

A Guide to Waiting Period Timeframes for Day 1 Health Hospital Plans

General Waiting Period – 3 Calendar Months (from inception of policy)

Pre-Existing Chronic Conditions 12 Calendar Months (for In-Hospital Illness Benefits)

Accident Benefit Immediate Cover

Accidental Permanent Disability Immediate Cover (Limited to a Single Event)

Don’t Wait until it’s too late to claim on your Hospital Plan

Regardless of what insurers tell you, or how many zeros are advertised in the range of benefits persuasively broadcasted on tv, radio, and digital, waiting periods are the reality which you have to factor in when signing up for a hospital plan in RSA. Study the Ts and Cs of a policy just as you would a cellphone contract or home bond. Day 1 Health offers one of the most generous waiting period concessions of any healthcare provider in RSA. Offering a range of tailored hospital plans, a comprehensive list of the most important elements of each plan is explained and answered on their Frequently Asked Questionspage.

Make sure you know what you’re covered for, but more importantly, when each coverage type kicks in. Make an informed choice and Apply Online Today.

South African Gap Cover –‘NO WORRIES’

‘Hakuna matata’ is a wonderful Swahili phrase popularised by the Lion King movie. It actually means ‘no trouble,’ but literally translated, it means, ‘no worries.’  Either way, ‘hakuna matata’ is the safety net that South African gap cover offers you.

Any in-hospital treatment, whether scheduled, a sudden illness or an emergency, is a time of stress – not only for the patient, but for their extended family as well. Sitting beside your child’s hospital bed, waiting for news from the surgeon, or visiting a spouse in post-operative ICU, is emotionally draining. In pressing times like these, financial costs should be the least of your worries.

The fact is that in South Africa, although medical aid schemes may cover the bulk of the cost of surgeries, specialists and post-operative care, they may not cover everything. There is often a financial shortfall, and whether that bill is large or small, that becomes your problem. This is where gap cover sweeps in to save the day.

In many instances, the procedure costs for hospital, or even outpatient treatment, exceed the base medical aid rate. This is an ongoing reality and is unlikely to change in the near future. It has been the bone of contention and one of the motivations behind the NHI bill and reform of the South African health system. But in the meantime, South African Gap cover is your essential measure and being prepared for it is a wise consideration. Private healthcare rates and medical inflation will continue to rise as private medical service providers are currently entitled to charge more than the medical aid rates.

This is the primary reason for which increasing numbers of South Africans are turning to medical gap cover as a top-up to their medical aid policy. Gap cover, by definition, is the solution for covering the difference between rates charge by medical specialists and what your medical aid pays.

Addressing a vital healthcare need, gap cover gives medical aid scheme members access to insurance to cover the gap which is created between the ever-increasing costs of medical service providers and the set rates which the medical scheme will pay. Unfortunately, no medical aid means no access to gap cover.

Hopefully, when your loved one is discharged from the hospital and you go to settle the shortfall on the medical bill, because you have South African gap cover, you will be able to confidently smile and say, ‘No worries, it is all covered.’

At Day1 Health, we offer a Gap Wise option. For more information regarding this gap cover and its benefits, visit our website to find out more or contact usto request a quote.

MEDICAL AID RSA – UNDERSTANDING WAITING PERIODS AND MANAGING EXPECTATIONS

Whether you are on medical aid RSA or medical insurance policyholder, there is no escaping the reality of waiting periods which place restrictions on your ability to claim. Waiting Periods have been around since the dawn of the insurance industry and are too often overlooked when deciding on the most suitable medical aid policy for your family. With a better understanding of these individual waiting periods, you can not only make an informed decision on what medical cover to take out, but also avoid any nasty shocks should you need to submit a claim during the early inception of your medical cover policy. It’s imperative you know beforehand what you are signing up for – the detail is in fine print!

Knowing your Waiting Periods before you sign on the dotted line.

Waiting Periods in the medical aid RSA and health insurance marketplace are defined as “the periods of time which must pass before some, or all of your health benefits can take effect” (Source)

When considering a policy, the first aspect you should look at is the Initial Waiting Period – the period of time which must lapse before any claim can be submitted (with the exception of accident cases). This can vary from 1 to 3 calendar months, depending on the medical aid provider’s Ts and Cs. Following initial restrictions, Pre-Existing Condition Waiting Periods will remain. These vary by condition and in essence mean that coverage for specific conditions will only kick in after a specified timeframe has passed after signing up on a medical aid policy.

Waiting Period Timeframes for Day 1 Health Stated Benefit Plans

Initial Waiting Period – 1 Calendar Month (most primary healthcare benefits)

Pre-Existing Chronic Conditions 12 Calendar Months

Maternity Benefit 3 Calendar Months   (Maternity Benefit limited to R20,000)

Optometry/Dentist Benefits 12 Calendar Months

Don’t Wait to find out when it’s too late!

No matter what medical aid companies tell you, or how many zeros are advertised in the range of benefits elegantly broadcasted on tv, radio, and digital, waiting periods are the reality which you have to factor in, when signing up for health cover. Treat the contract of a medical aid or health care policy just as you would a cellphone contract or home bond. Day 1 Health has one of the most generous waiting period concessions of any healthcare provider in RSA. Offering a range of Stated Benefit Plans, a comprehensive list of the most important elements of medical cover is explained and answered on their Frequently Asked Questions page.

Make sure you know what you’re covered for, but more importantly, when each coverage type kicks in. Make an informed choice and Apply Online Today.

HOSPITAL COVER SOUTH AFRICA – THE IMPACT OF WAITING PERIODS ON YOUR HOSPITAL PLAN

If you are on any form of medical aid or medical insurance product, there are waiting periods  built into your policy which will restrict your ability to claim from your hospital plan for certain periods of time. Waiting Periods have been around since the dawn of the insurance industry and are too often overlooked when deciding on the most suitable hospital cover in South Africa for your family.

It’s vital you know where you stand when taking out cover. Understanding waiting periods better ensures that you’re not on the receiving end of a nasty shock during the early days

of your hospital plan. Know what you’re signing up for in advance. Read on as we unravel the essentials.

Know your various Waiting Period Restrictions before you sign up

Waiting Periods in the medical aid and health insurance marketplace are defined as “the periods of time which must pass before some, or all of your health benefits can take effect” (Source) When assessing which SA hospital plan is right for you and your family, firstly take into account what the general waiting period of the policy is – ie the initial period of time that must pass from when you sign up, until you can legitimately claim for hospitalization benefits. It usually varies between 1 and 3 calendar months depending on the provider. The exception to this exclusion is Accident or Trauma Benefit, which has immediate cover. Pre-Existing Conditions are also tied into a hospital plan policy with exclusions normally enforced for the first 12 months of the policy.

A Guide to Waiting Period Timeframes for Day 1 Health Hospital Plans

General Waiting Period – 3 Calendar Months (from inception of policy)

Pre-Existing Chronic Conditions 12 Calendar Months (for In-Hospital Illness Benefits)

Accident Benefit Immediate Cover

Accidental Permanent Disability Immediate Cover (Limited to a Single Event)

Don’t Wait until it’s too late to claim on your Hospital Plan

Regardless of what insurers tell you, or how many zeros are advertised in the range of benefits persuasively broadcasted on tv, radio, and digital, waiting periods are the reality which you have to factor in when signing up for a hospital plan in RSA. Study the Ts and Cs of a policy just as you would a cellphone contract or home bond. Day 1 Health offers one of the most generous waiting period concessions of any healthcare provider in RSA. Offering a range of tailored hospital plans, a comprehensive list of the most important elements of each plan is explained and answered on their Frequently Asked Questionspage.

Make sure you know what you’re covered for, but more importantly, when each coverage type kicks in. Make an informed choice and Apply Online Today.