Late-joiner Penalties

Medical aid schemes, like most forms of health insurance, rely on a large membership base of young healthy people to support the healthcare needs of a small number of older, sicklier members. People who join medical schemes later in life are regarded as having skipped the supporting phase of membership and thus need to make up for this through higher premiums. These penalties are meant to encourage people to join schemes while they are still young and healthy.

Open medical schemes cannot turn down applications based on age, but can enforce late-joiner penalties in order to negate potential negative financial implications of adding older people as members. These late-joiner penalties can be applied to anyone who either joins a scheme or is added as a beneficiary on and after the age of 35 years. It is also important to note that this penalty will also apply if you have a break in medical aid cover anytime after the age of 35 years. If you decide to change schemes after this age you need to ensure that your application to your new scheme is accepted before cancelling your old scheme. This will ensure that no break in cover occurs. It is also important to note that should you belong to a scheme that has imposed a late-joiner penalty and then switch schemes, this new scheme may impose the same penalty.

If a late-joiner penalty applies then you will need to pay a loading on your contributions for as long as you are a member. This loading is scaled and can be worked out as follows: Add the number of years that you have had cover to 35. Subtract this number from your current age. For example, if you have had 4 years of cover you would add this to 35 giving you a total of 39. If you are 40 years old you subtract 39 from this leaving you with 1 year without cover. Loadings are scaled as follows:

• 1 to 4 years without cover = normal contribution x 0.05
• 5 to 14 years without cover = normal contribution x 0.25
• 15 to 24 years without cover = normal contribution x 0.50
• 25+ years without cover = normal contribution x 0.75

How does it work?

All the members of a medical aid scheme pool their money together. This money is collected monthly in the form of a premium. If a member requires medical services the money is taken from the fund to pay for this. The basic concept behind a medical aid scheme is that the majority of members will be young and healthy and will pay for the medical expenses of the older, sicklier members who are in the minority. Medical aid schemes also generate additional funds by investing the pooled funds.

The public health system in South Africa is extremely overburdened and is often mismanaged. This means that treatment is often of poor quality even though it is free. The alternative, private healthcare, is very expensive but very high quality. Medical aid schemes allow access to the private healthcare for a nominal monthly fee. Access to these top-class hospitals and doctors would otherwise be out of reach for most South Africans. The monthly premium is calculated based on factors like the amount of cover required, number of dependents, income of the policy holder and age.

Medical Aid vs. Health Insurance

Health insurance and medical aid differ significantly, but are essentially both insurance products, provided by service providers, used to cover medical expenses. Health insurance is a typical insurance type product where cover is paid for and if an incident occurs the claim is paid out. Medical aid is not incident based; it pays for medical services and products on an ongoing basis. Medical aid policies do not mature and do not include the numerous exclusions that health insurance policies have hidden in the small print.

One significant difference is that anyone may join a medical aid scheme regardless of their current health conditions. There is no discrimination as far as access to open medical aids other than a one year restricted cover period. Even if you suffer from HIV or cancer you may join any open medical scheme and enjoy full cover after one year. Health insurance policies typically exclude people from access based on current or past ailments. There are closed medical schemes that restrict access based certain factors like employer and level of education, but none may restrict access based on current or past health.

For the moment, medical aid schemes are the best option for South Africans who want private healthcare cover.

Critical illness insurance can give you sometimes vital financial aid in crunch times like these. If ever, you are in a position where you find yourself diagnosed with a critical illness, you will get a lump sum of money, tax-free to tide you over your hard times. However, there is a procedure to safeguard against unlawful claims but if your case is genuine; this insurance can be a huge help.

Critical Illness Insurance Cover

Under critical illness insurance cover, you get cover for a number of diseases listed as critical illnesses. Seven core categories are present in almost all policies. These are the following:

* Heart attack
* Coronary artery bypass
* Multiple sclerosis
* Cancer
* Major organ transplant
* Kidney failure
* Stroke

Other diseases and conditions that lead to disability are also in present in the policy.

To tighten the insurance claims the companies do not cover all categories in the above illnesses such as non-invasive skin cancer and cardiac conditions like angina. In case of cardiac problems, an ECG (Electro Cardiogram) will be necessary to prove changes in the heart or proof of typical chest pain to validate the claim.

Once the necessary proof is there, the insurance company will agree to release the payment. There is, however, a clause which states that the patient should survive for a certain amount of time before they release the payment, so it takes anything between 28-30 days to get the payment. In case of paralysis, it takes much longer as it takes more time to ascertain the paralysis. They release the payment in case of paralysis in about six months to one year.

Benefits Of The Insurance

Once you have the money you can do anything you want with it. Pay off your mortgage, pay the medical bills and even redecorate the house. This lump sum of tax-free money is absolutely yours.

The benefits to a family person with dependants or even in a relationship are far greater. In case you have dependants, this money will help you out tremendously as you can fall upon it and thus have a healthy and full recovery without bothering about the payments and other financial aspects. Similarly as in a family, if you are a couple the money will help you and your partner avoid the stress of wondering where the money is going to come from and give you a peace of mind that is necessary to rehabilitate from a critical illness. Critical illness insurance in this way protects your family.

If you do go in for critical illness insurance, be wise in deciding the policy and choose the right insurers. Be completely honest and truthful about your medical history when they question you about it, and be sure to be clear on what your policy covers and does not cover.

In California Medigap insurance plans are available as A-J in alphabetical order and it is always recommended for California residents to compare the available Medigap insurance plans before finalizing the best in accordance to the existing insurance plan. However the Medigap plans are apparently intricate and it is difficult to select between the options unless someone trade expert suggests on the issue. Therefore it is always good to consult a reputable insurance broker for selection of the right medicare supplement plan for best possible coverage.

In California each of the Medicare Supplement Insurance Companies receives certain rating depending on the customer satisfaction issues. There are many Medigap insurance providers in California insurance market who enjoy an” A” rating for the consistent track-record for customer satisfaction record. It is always recommended to avail medicare plan from “A” rated companies.

If the comparison is to be done between two same competent companies it is always expected that two similar policy pricing should be compared. In some cases the insurance providers start with lower premium range and then raise their premium range whereas some companies start with higher rate and retain their premium rate consistently in the same place. Premium wise it will be cheaper go for the insurance provider with higher premium rate.

Residents of California have their insurance purchase options with from different insurance providers and the purchase can be done either in direct mode or through an individual agent. The premium rates are controlled by Federal law; therefore, monthly premiums will be same for same category of Medigap insurance plans.

Californians enjoy an exceptional benefit on their birth month. By default, every California residents can switch to any preferred coverage plan. This yearly anniversary is called birthday rule. After the birth month, in California whoever wants to switch over insurance plans after his/her birthday month, he/she has to go through the medical underwriting process.

In California the existing insurance regulating law offers insurance for the persons above 65 years of age below 65 years of age, and those with medicare disability problem. In fact very few states offer this under 65 Medigap insurance facilities and in this regard California insurance scenario is unique and exceptional.

The Medicare supplement plans were originally standardized in 1992 and since then there had been 12 Medigap Health Insurance Plans to be sold and administered by the private health insurance companies only. It should also be noted that though these plans are under the direct administration of the private health insurance companies still it is not possible for any company to bring in any changes in the standard Medicare supplement plans. Therefore if anyone wants to purchase any Medigap insurance he can be sure of the fact that he will get the same benefits as mentioned by the standardization rules irrespective of the company he is purchasing the plan from. Besides that it should also be kept in mind that the private health insurance companies are free to fix the premium charges for these plans.

In this respect it is essential to note that though since their standardization in 1992 there had been no changes in the standard Medicare supplement plans but by July 2010 some new changes have been brought in the standard Medigap insurance. With these new changes four of the existing plans are being dropped and in their place two new plans M and N are being introduced.

These plans are of great help to the Medicare beneficiaries. Using cost sharing means and deductibles these plans are far better efficient in reducing medical costs. Besides that there are also some other benefits of these plans as well. In this respect it is also essential to note that it is believed that these plans are gong to prove to be quite beneficial for the beneficiaries and therefore these plans are hoped to get a warm welcome in the list of Medigap insurance and it is believed that these plans are going to gain a lot of popularity within a very short period of time.

If view closely Medicare Supplement Insurance Plans it we will eventually find that it is the best additional insurance coverage for people older for 65 and more. Medigap insurance plans cover the expenses of regular doctors’ consultation expenses and hospital check ups bills. Thus the purchasing a suitable Medigap Insurance plan signifies the availability of quality health care and fewer burdens on bank balance.

In California Medigap insurance market plan F is the most popular one amidst other nine existing Medigap insurance plans. The plan F covers Part A and B deductibles and 20% coinsurance amount that Medicare policy does not entertain for reimbursement. Additionally, Plan F covers Part B excess charges and also covers the health treatment requirement of the policy holder at the time of his foreign tour. Therefore if all the existing benefit of Medigap Pan F can be analyzed, it can be seen that this is the most comprehensive available Medigap Insurance plan in California and the over all coverage advantage is one of the prime reasons behind its undaunted popularity as the most opted medicare supplement insurance plans.

The most popular Medigap insurance service providers companies in California insurance market are Blue Shield, Mutual of Omaha, Anthem Blue Cross, and AARP, and almost all of these companies are accredited with “a” rating for their excellent service range and 100% customer satisfaction quotient. All these Medicare Supplement Insurance Companies have 10 existing Medigap insurance plans to offer their intended policy holders.

Although for a particular plan all these companies offer more or less same premium rates but altogether it is not easy to decide on a specific Medigap plan unless a common policy holder is professionally guided by an insurance agent. Altogether the premium rate of Medigap California depends on three factors like the age of the intended policy holder, the pace where the applicant resides, and the present physical condition of the applicant which means his medical history of pre-existing diseases.

In California those who are Medigap policy holders eventually enjoy some great advantages as the resident of this particular state. California federal laws has designed unique birthday rule for all Californians and according to this privilege a Medigap policy holder can switch to another similar or lesser coverage enables Medigap plan within 30 days of his/her birthday. This is great advantage plan hardly available in any other US states and it helps for thousands of senior Californians to save lots of dollars on purchase of the best suitable Medigap plan as per his/her latest health condition at each yearly basis.

You can trust on this plan 100% and will get the full coverage of the original one only after booking this. This special policy or plan is also known as medigap insurance plan simply because it bridges the laps or better to call the gaps between the actual and desired. Actually it is also seen that after a treatment gets finished the plan does not cover all the expenses as it is sated and the policy holder does not get the whole some of money that is spent by him. And he has to pay some money from his own pocket always in spite of having medical insurance. But it is not unnatural and unexpected as there are some boundaries for these types of insurance policies.

Take a look at the amount of money you spend on health care each year. After that, carefully and realistically estimate how much you intend to spend on health care in the future, taking into account your current health and circumstances. Make a list of how much you've spent and how much you will likely spend.

After deciding what medical assistance you need view various medigap insurance plans offered by various private companies. Read all the plans and their details carefully and then choose one which suits your needs. The reason is you can only choose one medigap insurance plan because Medigap insurance companies cannot sell more than one policy to you under state and federal law. There are 12 plans altogether for serving your needs. These plans are standardized by the state and federal guidelines. And though there are several many private companies offering the medigap plans but the number of plans and their facilities are determined as same by the law and order. All Medigap insurance plans must follow state and federal guidelines and regulations, which are designed to protect you and to ensure that you are adequately covered. There are also compare Medicare Supplement plan which will help you to decide and choose one medigap plan. There's also a chance that Medigap insurance is not for you. You should also investigate any alternative forms of coverage in order to determine if Medigap insurance makes the most fiscal sense for you. These options can include Medicare Savings Programs, programs for people with limited income and resources, Medicaid, retiree health insurance and prescription drug assistance programs.

But the fact that should always be kept in mind before choosing the Medicare supplement plans is to go through the offer documents very carefully so that you can get the best results on your Medigap insurance plans.

Medigap California plan A is the basic Medigap insurance plan.

Plan B covers basic health care benefits, and additional supplemental coverage related to Medicare Part-A hospital deductibles.

Medigap C plan covers Plan B coverage and additionally offers supplemental coverage for customers as per scheduled nursing home facility co-insurance of Plan-A, deductible of Part-B, and health care coverage during foreign travel emergency.

Medigap California plan D covers basic benefits, Medicare Part A included supplemental coverage; in addition to these basic benefits plan D covers health coverage during abroad travel and recovery coverage expenses at-home.

Plan E under Medigap plan in California covers basic benefits, supplemental coverage for Medicare Part-A’s coverage gaps, health care issues during abroad travel, and general preventive care related coverage.

Similarly, Plan F of Medigap plan covers basic health benefits of the policy holder, inadequacies of Medigap plan-A, supplemental coverage for deductibles of Medicare Part-B, health care coverage during foreign travel, and complete coverage of excess charge included in Part-B. The advantage of plan F has high-deductible option, which is especially effective for reducing the cost comprehensive insurance plan.

Medigap California Plan G is obviously a bit wide in its coverage than plan-F. This plan offers basic benefits, supplemental coverage for inadequacies from Plan A, health care benefits during foreign traveling, health coverage at-home recovery, and 80% coverage of excess charges [if any] included in Medicare Part-B plan.

Medigap insurance Plan H has additional coverage for prescription drugs. Apart from this significant health coverage this health plan also includes basic benefits coverage, adequate supplemental coverage for Medicate Part A plan, and health care issue coverage during foreign travel etc.

Medigap insurance plan-I covers prescription drug benefits and in addition to this benefit also takes care for health care benefits during foreign travel, recovery coverage at home, and 100% coverage of excess charges under Medicare B plan.

Medigap Plan-J covers basic benefits, supplemental coverage under Medicare plan A and B, health emergency requirement while in foreign travel, at-home recovery process, coverage for preventive care, coverage for prescription drugs, and complete coverage of excess charges incurred under Medicare Part-B plan.

There are different types of plans available against Medigap insurance plan and according to the coverage issue the premium of Medigap policies vary largely. Medigap insurance plan is never done in group and it is valid for only one person. For example if a Medigap policy is to avail against a couple, both of them will have two separate Medigap schemes. Medigap plans are always mentioned in front of the policy paper and Medigap policies are designed as per the recommendation and provisions of State and Federal laws.

Before knowing the benefits of Medigap plans it is wise to know the other side of the coin which means which factors are not covered by this supplementary insurance policy plan. The plans like Medicare prescription drug plans, Medicare advantage plans, Medicaid, benefits programs, Employers’ plan, TRICARE, and veterans’ benefits are not covered by Medigap policy coverage. Medigap policies are available different plans and it is therefore recommended to know the available plans from your health insurance agents.

Although the benefits of Medigap insurance plans largely differ from one service provider to another and according to policy premium range, the common benefits of basic Medigap insurance plans are described here.

Medicare Supplement Insurance Companies are the only authorized points that can sell you a Medigap policy. However, the benefits and coverage will differ from one plan to other but each standardized policy will offer same array of benefits irrespective of its provider. The basic benefits of Medigap policies are Medicare Part A Coinsurance, Copayment or Coinsurance related to Medicare part-B, Blood cost up to first three pints, Hospital costs up to an additional 365 days post-medicare benefits, Coinsurance related to skilled Nursing facility expenses, copayment or Coinsurance for Part A Hospice Care, etc. Additionally, there is other coverage within Medigap insurance plans like deductible Medicare Part-A, part-B, part-B excess charge, health emergency during foreign travel, recovery expenses at home, part-B Medicare Preventive Care coinsurance, and list of preventive cares not covered by medicate original policy.

In this context it is also important to know about the factors which are not covered by Medigap insurance plans irrespective of the availed plan. These are long-term care in nursing homes, optical and dental care, costs of hearing aids, expenses incurred for eyeglasses, the cost covered by private-duty nursing facility or arrangements.

With the Obama government introducing the new health care reform bill, health insurance is now a reality for a lot more people. Affordable health insurance is easily available online as well. Now is the best time to make this investment.

For beginners short term health insurance is the best option because it helps you buy some time. Without burning a hole in your pocket you are able to get a decent health insurance for immediate purposes. You can definitely go in for a long term plan after sometime. These low cost short term health insurance plans can act as a stand by till the time u find the right long term plan.

Moreover for people who are between jobs, short term health insurance is the path to take. HealthInsuranceBluebook.com provides some excellent short term health insurance plans which will hold you in good stead. Those who are between jobs might lose their previous employer’s health cover and the time lag between obtaining the health insurance cover from the new employer may be long. So for this time a low cost short term health insurance is the best.

Tough being a student these days right? A whole range of short term health insurance options available on HealthInsuranceBluebook.com can take care of your insurance worries at least. A student normally survives on a limited budget and investing in expensive long term plans just doesn’t make any sense. Instead going in for short term health insurance options is a much wiser choice and with no dearth of affordable options the process of finding the right plan is just about finding the right site online. HealthInsuranceBluebook.com is one such site which now takes care of all such health insurance related requirements. You can find the best low cost short term health insurance plans here.

Self employed persons are another category who may find this type of health insurance particularly appealing. No entrepreneur wants to spend large amounts of time and money on health insurance just when he’s starting out. So going in for a low cost short term health insurance plan is definitely a better choice. It provides you with the necessary cover and allows you to chalk out your long term health insurance requirements over a period of time.

Using a medical aid broker to help you way up your options can help, but unfortunately brokers are biased towards schemes that they have relations with and will try to convince you to sign up with one of them instead of giving you impartial advice. Like they saying goes, "If you want something done right, do it yourself". Comparing monthly contributions is simple enough and can be easily done using a number of price comparison websites. However there are other variables that need to be compared before making a decision. These include:

Limits

Low and mid level scheme options typically have overall benefit limits and sub-limits. If the overall benefit is capped then it is essential that you check whether this limit applies to the main member and all dependents separately or if it applies to a combination of all members and dependents. Then check whether the benefits are sufficient to cover your entire family should you all be involved in a car accident. Sub-limits are also important. These typically come in the form of a limited number of GP visits per year or a limited number of eyeglasses per year.

Exclusions

Check if any conditions or procedures are excluded. Not having cover for treatments like transplants or chemotherapy could cost you or a loved one their life.

Networks

Some medical scheme options use medical services networks to bring down the cost of contributions. There are usually three types of network options. Unlimited private options mean that you can use any hospital or doctor. Limited network options entail only being able to use a list of hospitals and doctors that are approved by the scheme. By creating these networks schemes are able to control costs better. Some low-cost options involve the use of public hospitals in their networks.

Reference Price List

The Department of Health has a list of guideline tariffs known as the Reference Price List (RPL). Many medical schemes in South Africa use these rates to set their benefits. However, many doctors charge above the RPL rate meaning that you end up paying this extra cost yourself if you are not adequately covered. Typically benefit options will cover 100% RPL, 150% RPL, 200% RPL or 300% RPL. The RPL rate is a crucial factor to be taken into account when comparing schemes and benefit options. To make things even more confusing, some schemes have rates of their own that are loosely based on the RPL and refer to them as ‘Scheme Rates’. Trying to compare an option with 100% RPL to an option with 100% Scheme Rates is futile.

When you apply to join a medical scheme you will possibly be confronted with waiting periods and late-joiner penalties. All too often people try to bend the truth in order to get around these restrictions and penalties, but this inevitably backfires and results in monetary losses and even possibly impact on your health. It is better to be honest when completing your medical aid scheme application form and to go through the waiting period.

Your application will include a section on the medical history and condition for both you and your dependents. This is referred to as 'material information' and is used by medical schemes and insurance companies to calculate the risk of taking you on as a member. Material non-disclosure is legal terminology that basically means lying on your application. If you do lie on your application then the scheme you have joined has the right to cancel your membership and to refuse to pay for your medical bill.

A medical scheme can not make you pay more for your membership due to an existing medical condition. This means that you do not need to lie in order to join the scheme you have chosen. However, the medical scheme can impose a condition-specific waiting period of no longer than twelve months. Typically a twelve month waiting period will only apply if you have not belonged to a medical scheme for longer than two years or you have waited more than ninety days between changing schemes.

Do not be fooled into thinking that there is no way for your scheme to find out whether you have lied or not. Non-disclosure is checked via hospital admission records, chronic medication applications and a variety of other medical records.

With such minor restrictions and penalties, lying does not make sense. The waiting periods are far less of an issue compared to the chances of having your membership being cancelled and your medical expenses not being covered. There have been many cases where members or their dependents have been admitted to hospital due to a pre-existing medical condition and have racked up hefty bills. At this point non-disclosure has been discovered and membership has been cancelled. This has left people with expensive, unpaid hospital bills.

Non-disclosure that occurred via a broker is also terms for cancellation of medical aid scheme membership, so it is no use trying to use a broker as a buffer. It is also essential that you check that your medical broker completes your application correctly and if possible fill in the form yourself. If you do not want to do it yourself then make a list of pre-existing medical conditions for you and your dependents and send it to your broker.

Make sure that your application form is completed accurately and truthfully. This will guarantee that you are not left stranded without medical cover which could possibly cost you your life or the lives of your dependents.