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Thread: Advice please - Medical

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    Diamond Member HR Solutions's Avatar
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    Advice please - Medical

    Can someone please give me some advice. My father in law (74) was on a medical insurance, which paid out up to R30 000.00 per visit, therefore enabling him to get rushed off to a private hospital and get treated by them for a few days.
    Unfortunately he did not take care of medical aids etc before. Two months ago he changed banks and the medical insurance lapsed, he went into a diabetic coma a week ago and was taken off to a government hospital, because he now did not have this medical insurance. We have contacted the bank who admit it is there fault that they did not change the debit orders to his new account because they had said they would. The medical insurance is now not interested because obviously to them the policy lapsed. The also will not take him back on because he is too old.

    Can anyone advise what to do for future - anyone know of a reasonable medical insurance that will take him ? I also do realize that normal medical aids will also either reject him or charge an astronomical amount to cover him, which he does not have.

    Any advice would be appreciated - thank you.
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    Email problem Rafael's Avatar
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    The most important thing for your father in law is to have cover in hospital unless he has the funds available in the event he is hospitalized, if not then he needs to have at least a Hospital plan.

    Medical aids cannot reject him but they can put a maximum 1 year waiting period on a pre-existing condition and a 3 month waiting period on the medical aid. They will definitely put a 3 month waiting period.

    The maximum late joiner penalty that can be charged is 75% (dependent on how long he has been off a medical aid).

    I deal with Liberty Life medical aids, so I would do the following in an event like this.

    I would put the client on our traditional basic (for clients that earn less than R6500 per month). It is R709 per month with a 75% late joiner penalty fee, it would cost a total of R1240.75.

    He would then have unlimited hospital cover for emergencies and R750 000 limit per annum for planned procedures (e.g. removing your appendix).
    He would also have to use a network of hospitals and still get 6 free gp visits and 1 dentist as long as they part of the network.

    So If I was in your shoes I would look at a schemes lower options as long as they have hospital cover, you should be fine. And also read the fine print if its to good to be true it usually is.
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    Diamond Member HR Solutions's Avatar
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    I would put the client on our traditional basic (for clients that earn less than R6500 per month). It is R709 per month with a 75% late joiner penalty fee, it would cost a total of R1240.75.
    Thank you for coming back to me Rafael. So if I understand you correctly - He is a pensioner therefore does not earn any salary. Therefore am I to understand it would cost R709 per month with the first month being a late joiner penalty fee of R1240.75, but thereafter R709 per month.

    He had medical insurance, not medical aid for a while so would this not stop him getting medical cover ?

    Is this something you do ? Is this something you could do if he wanted to go for this ?



    Ps: Is this per person ? what would the cost be for both of them ? ie wife as well.
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    Email problem Rafael's Avatar
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    You are correct, but it would cost R1240.75 every month going forward.

    The 75% penalty is worst case scenario, it could be 25%, or 50%.

    Even though he never had medical aid, it would be illegal to refuse him cover. I have just registered a 88 year lady on our plan who has not had a medical aid for 15 years.

    An additional dependent would cost R676 (excluding penalties), with a 75% penalty it would cost R1183.

    This is something that I could do for them and I can motivate it to see if I can bring down the penalty fee's.
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    Platinum Member sterne.law@gmail.com's Avatar
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    Check if policy has a 're-reinstatement clause
    Anthony Sterne

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    DISCLAIMER The above is merely a comment in discussion form and an open public arena. It does not constitute a legal opinion or professional advice in any manner or form.

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    Gold Member Houses4Rent's Avatar
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    I would say since it was the banks fault I would argue the case with the Medical/Health Insurance Ombudsman.
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    Diamond Member HR Solutions's Avatar
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    Thanks for input everyone.
    Rafael - you say that the penalty's could vary between 25-75% ? Is there any way that one could find out exactly how much it would cost as obviously this is quite a big difference to a pensioner ........ and now us and immediate family which is going to have to help them out !
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