Why medical schemes limit members to once-a-year policy changes

Medical schemes only allow members an opportunity to either downgrade or upgrade their medical aid once a year.

But what happens if a member cannot afford to pay the current premium in the middle of the year due to unforeseen circumstances?

Are medical schemes allowed to prevent members from downgrading their medical scheme in the middle of a benefit year?

Paresh Prema, General Manager at Council for Medical Schemes says according to the Medical Schemes Act, it is compulsory for medical schemes to allow members an opportunity to change their option and it usually occurs between October and December.

If the scheme wants to allow further changes during the year it is up to the board of trustees of the scheme to allow that to happen.

Paresh Prema, General Manager at Council for Medical Schemes

Prem says if the medical schemes wanted to allow members to change their options outside the set periods, they could allow it.

To hear the rest of the conversation with Paresh Prema, listen below:


This article first appeared on CapeTalk : Why medical schemes limit members to once-a-year policy changes


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