Who should be the main member of your medical aid scheme?

Medical aid plans are designed to accommodate families by allowing them to have a main member on their account and a range of dependents.

This structure can be useful, but if you have two adults on the same medical aid plan, how can you decide who should be the main member?

Tip: If you don’t have medical aid yet, or you’d like to switch, click here to get a quote.

Why are there main members and dependents?

According to Iracema Fonseca, medical aid and life cover consultant at Independent Financial Consultants, the main member usually pays a higher premium if there are no late joiner fees.

“The adult dependent would usually pay less and children normally pay less than the adult dependent and the main member,” says Fonseca.

“This is done in order to make the cover more affordable for families. Note that day-to-day benefits are also adjusted based on the contributions they pay, as well as family size,” she adds.

Fonseca explains that most schemes do not charge after three children – but this is not always the case – and if a child joins alone, they pay an adult rate.

READ MORE: Medical aid plans and hospital plans: What’s the real difference?

Among spouses, who should be the main member?

Fonseca says that she would always advise the younger spouse to join as the main member if late joiner penalties are applicable.

“This is because the penalty is a percentage of that person’s premium and, since the main member usually pays more, this would be a way of reducing the amount paid by both in the end,” says Fonseca.

“Where late joiner penalties aren’t applicable, it shouldn’t matter who is the main member because the day-to-day benefits are usually placed into a pool of benefits which can be accessed by all,” she explains.

Fonseca points out that the main member should have access to email, since they will receive communication from the scheme and they will have to make changes when needed.

According to Lee Callakoppen, principal officer at Bonitas Medical Fund, deciding who should be the main member depends on who pays the contribution. However, he adds that it’s ultimately an individual’s decision.

All else being equal, check with your accountant to find out who would qualify for greater tax kickbacks as the main member of your medical aid; you or your spouse.

READ MORE: What to do when your ex kicks you off their medical aid

Responsibilities of the main member

Callakoppen says that the main member is responsible for the maintenance of the membership, such as providing information, making payments, engaging with the medical scheme, and so on.

“In some instances, the main member has access to greater benefits but this depends on the specific medical scheme and the option selected. The main member acts on behalf of the dependents and is bound by all the terms and conditions that form part of their membership,” says Callakoppen.

“The main member is also responsible for ensuring that they have provided accurate and relevant information when filling in the application form, particularly in relation to pre-existing conditions,” he adds.

Fonseca says that the main member gets the updates on changes and needs to make sure they share this information with the dependent.

“In terms of pre-authorisations, the dependent has the right to deal with the scheme but only the main member can sign documents and make changes to the cover,” says Fonseca.

What else should you keep in mind?

When taking out medical aid for your family, Fonseca suggests looking at affordability first because if you cannot afford it, there’s no point taking out an unsustainable option.

“Once this box is ticked, you should then look at health (chronic illnesses, etc.) and things like travel insurance should not be overlooked either. You can chat to your provider about your budget, illnesses, and previous medical aid history, and they will find an option that best suits your needs,” says Fonseca.

Callakoppen offers the following additional tips when applying for medical aid:

• Disclose all information about you and your dependents’ health. Membership can be suspended or cancelled if you fail to do so.
• How good is the payment record? Phone your general practitioner’s receptionist and find out whether they have experienced problems with pay-outs from that particular scheme.
• Scrutinise the table of benefits. Things might look good on paper but do check what the day-to-day limits are and how much your medical savings account is per year. If it’s small, you could exhaust your day-to-day cover quickly. Also, remember that many private hospitals don’t charge medical scheme rates, so check which co-payments you will have to make.
• Are there any waiting periods or exclusions? Schemes may impose certain waiting periods for new members joining or for a pre-existing medical condition. This is based on the guidelines of the Medical Schemes Act and the specific scheme’s rules.

Cover your family for medical expenses today by getting a quote for medical aid here.