In this snippet we’d like to deal with some common queries as well as misunderstood rules and regulations within the Medical Aid and Gap Cover landscape.

Can a medical aid terminate my membership while being a member?

The simple answer is yes.  These are some of the reasons:

  1. Non-Disclosure: This applies while applying for your membership.  If a medical aid determines that you did not fully disclose your health while applying, the scheme may refuse to pay for your treatment and may ask that you re-apply so that they can correctly underwrite your application.
  2. Vitality: Many members are cheating the points system by logging points or claiming for exercise that is false or they did not do.  This would include for example a husband and wife uploading the same health data recorded from the same device for the two of them.  Although we haven’t heard of someone being kicked off the scheme, Discovery have recently issued a warning and are taking a dim view on such offenders.
  3. False claims: The scheme will charge you with Fraud.
  4. Trying to belong to two medical aids at the same time: Schemes will not accept you until you have terminated your membership with your current scheme.  The receiving scheme will push out your start date.

Can I terminate my membership at any point in time?

Yes, you can.  However, you have to give 1-month’s notice to the scheme.  The scheme will hold you liable and if you reverse the debit the scheme will come after you for the payment.  We know of some people who have been blacklisted for such an action.

Oncology Cycle – Is this different to my normal benefits

Your benefits run from the 1st January to the end of December each year.  However, your oncology cycle (12-month cycle) is individualised depending on when you are diagnosed with cancer.  If you are newly diagnosed and registered on the Oncology programme for example on 1 April 2019, then your 12-month cycle will begin and the cover amount will renew 12 months later on 1 April 2020.

Can I change medical aid options during the year?

Schemes will allow you to downgrade during the course of the year – NOT upgrade.  Upgrades will only be allowed from the beginning of the following year.  Most schemes will send out the new rates and benefits in October each year and require that you inform them of your option choice early in December.

Can I join a medical aid later in my life with no penalties or consequences?

Schemes will impose a late joiner penalty if you have not belonged to a South African medical aid from age 35 and onwards.  This penalty is for life, it is not a once-off penalty.

The late joiner penalty is applied as follows:

Total Years Uncovered
0 – 4 years
5 – 14 years
15 – 24 years
25 years or more		 Late-Joiner Fee
5% of contribution
25% of contribution
50% of contribution
75% of contribution


Can I be on GAP cover without a medical aid?

A person cannot be on GAP cover without a medical aid.  GAP covers the difference the rate at which the scheme covers you and what the specialist charges.

Is there an age limit for GAP cover?

Some GAP providers do have a maximum entry age and some don’t.  Most schemes without a maximum entry age do charge a higher premium for the cover.

Are my GAP cover premiums tax deductible?

As much as you may insist, they are NOT.  Payouts from GAP cover claims are tax free and are paid to you, which you need to use to pay to your service provider – the shortfall only.

Does GAP Cover pay for all shortfalls?

Just like any policy or insurance there are limits and restrictions.  Exclusions and waiting periods also apply.  Most people think that consultations are also covered.  We’d advise that you familiarise yourself with the policy rules to avoid disappointment.