The last few years have been a bumpy ride – particularly when it comes to our health. If you belong to a medical aid scheme, you may find that your needs and lifestyle are different now to what they were when you first joined. Not only that though. The pandemic has also had an impact on many people’s financial and employment situations, in far reaching and dramatic ways.
If this is the case for you, whether you’ve lost your job or faced a health scare, you may be thinking of changing your medical cover to fit your current needs better. As per South Africa’s Medical Schemes Act, you’re legally allowed to change your benefit option at the beginning of January each year. Most schemes require you to give them a notice period to do this, so they’ll prompt you to make a change towards the end of the previous year.
So, what could cause you to change your medical aid cover? Here are five situations where you may need to upgrade or downgrade your cover:
- You get married
Is that wedding bells we hear? Congrats! If you and your partner are each on your own medical aid plan, it may make sense to consolidate into one plan when you get married. Note that most medical schemes make provision for a partner or a spouse – so if you’re unmarried but have a long term partner, you could also consolidate your coverage with them. If you do this, one partner would be the main member, with the other being an adult dependant. While this may result in a cost saving, it will certainly help from an admin perspective in terms of consolidating claims processing, medical savings and even rewards points. It can also help simplify calculations if you’re setting up a joint household budget and tracking monthly expenses.
- You fall pregnant
Planning to paint the nursery soon? If you’ve recently fallen pregnant – or even if you’re just thinking of starting a family – you may decide you want to upgrade your plan to give you more cover for the increased medical costs you’ll face in future once you have a child. Whether it’s medication for childhood illnesses, paediatrician visits, or simply added maternity benefits while you’re pregnant, a more comprehensive option can give you the financial cushioning you need to afford the needs of your growing family.
- You’re diagnosed with a dread disease
Sometimes life throws us curveballs – such as being diagnosed with a dread disease like cancer or diabetes. Inevitably this comes with increased medical costs for things like testing, hospital procedures and chronic medication. Moving up to a more comprehensive medical aid plan can help alleviate the stress of paying for these added expenses yourself. But it’s not possible to predict exactly when we (or one of our dependants) will face this kind of diagnosis – so it’s not always ideal to wait until the end-of-year window to change cover. Luckily, medical aids like Fedhealth have realised this, allowing you to upgrade or change your plan at any time of year within 30 days of a diagnosis of a dread disease. This means you can get the increased cover as soon as you need it.
- Your financial situation changes
The pandemic and the resulting global recession have caused significant economic strain, and South Africa has been particularly affected. According to Stats SA, although South Africa’s unemployment rate is now recovering for the first time in two years, it’s still at 34.5%, as of the first quarter of 2022.
While many people have lost jobs or had their businesses fold, others have managed to keep their employment but have had to take on reduced hours or salary cuts. In these situations, things like medical aid become less affordable given reduced monthly incomes. If this is the case for you, you may decide to reduce your monthly contributions in return for lighter medical aid cover. Before you do this, make sure you weigh up the risk of reduced cover against future medical expenses you or your dependants may face.
- You’re getting older and need more coverage
When you’re young and healthy, having medical aid is far less of a priority than when you’re older and facing chronic or age-related conditions. If you or your dependants are ageing, you may need to upgrade the cover you have, so that these added medical costs for things like screening, medication or ongoing treatments can be covered by your plan. The Covid-19 pandemic also highlighted that if you’re in an older age group, you’re more vulnerable to falling ill or needing medical attention. For all these situations, a more comprehensive level of cover may make more sense for you.
The last two years have shown us that change is a constant, and it’s hard to predict the future. Whether you want to upgrade or downgrade your medical aid plan, it’s important to take a holistic and long term view and look at your own personal needs and circumstances. Whatever you decide to do, weigh up the risks and benefits of making a change, so that you’re left in the best financial position for an optimal level of medical aid cover. Health is wealth after all – and we need to make it a priority.
