South Africans face potential lifelong penalties if they delay reviewing medical schemes, experts warned during a Daily Maverick webinar. Hosted by Neesa Moodley, the session featured advice from Zee Gumede and Fazlin Swanepoel on aligning coverage with health needs and avoiding common pitfalls. With year-end approaching, timely decisions are crucial to prevent denied claims and extra costs.
The Daily Maverick Money Cents webinar, held ahead of the 2026 open season, highlighted risks of overlooking medical scheme fine print. Neesa Moodley, Business Maverick editor, moderated discussions with Zee Gumede, a consultant at GDC, and Fazlin Swanepoel, head of Alex Forbes Health.
Late-joiner penalties emerged as a major concern. Gumede noted that individuals joining after age 35 without continuous accredited coverage face fees from 5% to 75% of monthly contributions, based on uncovered years. Health insurance policies do not qualify as cover. 'Try to join a medical scheme before you turn 35, or ensure you’ve had continuous creditable cover, either as a dependant or main member,' Gumede advised.
New members typically undergo underwriting, including waiting periods of three months to one year, with up to 12 months exclusion for pre-existing conditions like pregnancy or kidney disease. Swanepoel explained, 'Underwriting protects the scheme and its members from anti-selection... keeping the system financially sustainable and fair.' Group employment benefits often skip underwriting and waiting periods.
Switching schemes requires precision to avoid gaps. It is illegal to belong to multiple schemes, and interruptions trigger penalties. Members must give 30 days' notice; for a January switch, notify by November 30 to ensure seamless coverage.
With over 70 schemes available, Swanepoel urged evaluating financial strength, including the mandated 25% solvency ratio, governance, and benefits value. Designated service providers (DSPs) are key—using out-of-network options leads to copayments. Prescribed minimum benefits (PMBs) cover 271 conditions and 27 chronic illnesses like diabetes and asthma in full, if protocols are followed, from the risk pool rather than savings accounts.
Gumede stressed registering chronic conditions via ICD-10 codes through a practitioner, as unregistered claims draw from day-to-day benefits. Review past claims to spot patterns, such as early savings depletion or repeated copayments, as red flags.
Hospital plans suit healthy, young individuals but exclude non-admitted emergencies. All experts recommended consulting independent financial advisers for personalized analysis. Additional perks like gym memberships or travel discounts increasingly influence choices.