Wealth and Legacy™ Group assists individuals, families and employer groups with medical aid and gap cover selection, review and ongoing support. Our role is to help clients understand the benefits, limitations and costs of the available options so that cover can be matched appropriately to their healthcare needs and broader financial circumstances.

Choosing and reviewing medical aid

Medical scheme options can differ significantly in respect of hospital networks, day-to-day benefits, medical savings accounts, chronic medicine benefits, designated service providers, co-payments, limits and contribution levels. We assist clients with comparing these features rather than focusing only on the monthly contribution.

We can also review an existing medical aid arrangement where a client’s healthcare needs, family circumstances, affordability or available scheme options have changed.

Our medical aid services can include:

• Comparing suitable medical scheme and benefit options;
• Explaining benefits, exclusions, networks, savings arrangements and co-payments;
• Reviewing whether an existing option remains appropriate;
• Assisting with applications and membership changes;
• Adding or removing dependants where appropriate;
• Assisting clients to understand scheme benefits and administrative requirements; and
• Supporting annual option reviews and changes where required.

Gap cover

Gap cover is a supplementary insurance product designed to address certain shortfalls between medical scheme benefits and qualifying healthcare costs, subject to the terms, limits and exclusions of the relevant policy.

We can assist clients with assessing whether gap cover is appropriate alongside their medical aid and with selecting a suitable option based on the medical scheme arrangement and the client’s circumstances.

Waiting periods and late joiner penalties

Medical schemes may impose waiting periods in certain circumstances. The position depends largely on the applicant’s previous medical scheme membership and how long any break in cover has lasted.

Previous medical scheme membership	General waiting period	Condition-specific waiting period
No previous medical scheme membership, or a break in membership of more than 90 days	Up to 3 months	Up to 12 months for qualifying pre-existing conditions
Previous membership for less than 2 years, with a break of less than 90 days	Generally not applicable	Up to 12 months for qualifying pre-existing conditions
Previous membership for 2 years or more, with a break of less than 90 days	May apply in certain circumstances	Generally not applicable

Prescribed Minimum Benefit rules and other statutory exceptions can affect how waiting periods apply in a particular case. We therefore consider the applicant’s membership history and circumstances as part of the advice and application process.

Late joiner penalties may apply to qualifying applicants aged 35 or older. The penalty is based on the number of years without creditable medical scheme cover after taking previous qualifying membership into account.

Years without creditable cover	Maximum late joiner penalty	Equivalent contribution
1–4 years	5%	1.05 × contribution
5–14 years	25%	1.25 × contribution
15–24 years	50%	1.50 × contribution
25 years or more	75%	1.75 × contribution

A late joiner penalty is added to the applicable contribution and may continue for as long as the member remains subject to it. Evidence of prior creditable medical scheme cover can reduce the penalty where applicable.

Employer groups

We also assist employer groups with medical scheme arrangements and employee healthcare benefits, including scheme and option selection, employee onboarding support and ongoing reviews. Broader group risk and employee benefit arrangements are addressed through our Employee Benefits service.

Medical schemes and providers we work with

We can assist with appropriate solutions from a range of established medical schemes and related providers, including:

• Bonitas;
• Discovery Health Medical Scheme;
• Fedhealth;
• Medihelp;
• Momentum Medical Scheme;
• Profmed; and
• Stratum Benefits.

The recommended solution is based on the client’s healthcare needs, affordability and broader financial circumstances rather than the promotion of a particular scheme or provider.

Medical Aid & Gap Cover within the Wealth and Legacy Plan®

Healthcare funding can have a material effect on a client’s broader financial plan. Where appropriate, medical aid and gap cover are therefore considered alongside the client’s Wealth and Legacy Plan®, including cash flow, risk protection, retirement planning and other financial priorities.