A very interesting and very important question is whether or not medical aid companies can refuse to accept members. This is fact a question that gets asked more often than any other medical aid related question, the main reason for this is because there are many newly economically empowered South Africans who for the first time ever are able to invest in their own health by buying a medical aid scheme. The majority of people looking for a first-time medical aid plan have not been informed about all the ins and outs of these schemes and thus they are afraid that they will not be approved for a medical aid plan.
There have been generalizations that medical aids will only accept people that have a lot of money, or people that are completely healthy with no medical issues at all. This is not true; most people will be accepted by a medical aid; however they will be put on different plans, or have certain clauses worked into their contracts to accommodate both parties. People with chronic illnesses can also join a medical aid and they might in some cases pay a higher instalment or have fewer benefits, because at the end of the day it all boils down to risk and they will have to work out a plan that is mutual beneficial for all parties. Medical aids are not only for healthy people, they are available for all people; which is why there are different plans, pricing structures and benefits involved.
Another rumour that have done its rounds is that a medical aid company can refuse to accept you if you are very sick or if you have a certain disease like HIV or any other kind of medical condition such as diabetes or cancer. This is quite untrue, and by law it is prohibited by any medical aid company to refuse you on any medical grounds. This is also the case for pregnant women; medical aids cannot refuse to sign you up. What medical aid companies can do is to accept you as a new medical aid member but with certain exceptions or clauses for a certain time period included in your contract. A good example of this is if you want a medical aid but you are already pregnant. A medical aid scheme will accept you as a member, but will not cover medical costs relating to doctor’s visits for a certain time period, which is usually the first three months after you have joined with them. This can vary depending on the medical aid company.
Lastly, it is very important that you are honest and upfront with a medical aid company when you apply for a plan. Always practice full disclosure when answering questions because it can really only benefit you in the long run if you are totally honest with the medical aid company. They will find a suitable medical aid plan for you that are customized for your individual needs.
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