Medical aid dependants: 7 questions answered

– Tanya Motlafe (Director, Cornerstone Healthcare Consulting Services)

This time of year, many medical scheme members add and remove dependants from their medical aid plans. To say that the world of medical schemes and hospital plans is often incredibly difficult to understand, would a massive understatement and for many, adding a new dependant can be a very daunting and strenuous task.

Fortunately, understanding the inner workings of medical schemes is our forte and with Cornerstone Healthcare Consulting Services at your side, you can rest assured that you will have access to expert advice to help you make the best possible decision for you and your dependants. Click here to learn more about our bespoke services for both businesses and individuals.

If you are thinking of adding a new dependant to your medical aid plan, you probably have a lot of questions. To help you get started, here are the answers to some of the most common questions we receive.

Who is a dependant?

In terms of the Medical Schemes Act, no medical scheme may refuse to add a person who is dependent on the member. Dependants of a member is his/her spouse or partner; children under the age of 21, or children older than age 21 who is financially dependent on the member, or they are mental or physical disability, whom we refer to as true dependants. Father and mother of the member do qualify as dependants provided, they are financial dependent on the member.

Who can I add as a dependant?

Your true dependents, it’s important to identify your specific dependant need before choosing a scheme and medical aid plan. Should you wish to add any extended family members (grandparents, nephews, sisters, etc) as your dependants on your medical aid, the scheme may require proof of legal guardian and they must be financially dependent on you.

My child recently turned 21, can they stay a dependant on my medical aid?

Yes, they can, however their contributions may increase depending with the rules of the scheme, as some medical schemes allow your child to remain a child dependant up to the age 26 provided, they are full time students. It’s always advisable to contact your medical scheme or better yet, your medical aid broker before your child turns 21 to find out what the financial implications will be and to explore alternatives.

Also read: Is your child dependant on your medical aid turning 21 soon?

Why do my dependants have reduced medical aid savings?

Although it may seem that dependant’s medical aid savings are less than the main member’s, it isn’t true. Most medical aid savings accounts are made up of a one percentage of your monthly contributions and because dependant’s contributions are less than the main member’s, the savings account will also be lower. The percentage may vary depending on an option plan one is on.

Do dependants have the same level of risk benefits than the main member?

Yes, all dependants will enjoy the same risk benefits as main members.

I have Gap Cover, is my dependant also covered?

Yes. As long as you have an active medical aid policy, some Gap Cover policies will cover you and all your dependants, both children and adults. Even when your dependants turn 21 and they choose to take their out their own medial aid plan, your current Gap Cover policy may continue to cover them up to the age of 26.

When can I add or remove dependants?

Unlike benefit options upgrades, you can add or remove dependants at any stage.

Will dependants be subject to waiting periods?

If your dependant is a minor, or they never had a break in cover or pre-existing conditions, they shouldn’t be a waiting period, however if the child has pre-existing conditions, there will be a waiting period that can span between three and twelve months.

If you are adding an adult dependant, there will be a general waiting period of three months and if the dependant has pre-existing conditions, the waiting period will extend to twelve months.  If the dependant has not been on a medical aid before or has had a break in cover for more than 90 days, a late joiner penalty fee will also be imposed.

If you have any questions about your current medical aid plan or dependant, regardless of the provider, remember to contact Cornerstone Healthcare Consulting Services today. We are totally independent and can provide expert advice on a variety of medical schemes so that you can get the best cover that suits your needs and your pocket. Also, don’t forget to follow us on Facebook and LinkedIn and subscribe to our newsletter for more informative and useful content.

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