Medical aids have a rule that the main member has to be over 18 years old since any younger person is a child and therefore a dependent. Not to confuse the issue though, a child of the main member that is older than 18 years and up to 26 years can also be considered a dependent if they are studying and are supported by the main member. A medical aid for children only can prove to be a major problem especially when there is divorce, remarriage or death of the parents with a guardian taking responsibility for the minor(s). Whether it is a full (comprehensive) medical aid or a medical aid hospital plan only, a child or children need to be under a main member who is 18 years and older. A person’s health status or employment does not matter. It’s a matter of the age of the main member.
Medical Aid After Divorce
Divorce is one of the most disruptive events in a person’s life and it affects the children in many ways, including their medical aid cover in some instances. Sometimes a single parent cannot afford medical aid for themselves but is receiving maintenance for the child to be on medical aid. Then there is the situation where a parent paying the maintenance for the child will refuse to pay for medical aid if the other parent is on, even if they do not have to pay for their ex.
Another issue may be that of remarriage where neither parent may want the child on their medical aid or that of their new spouse. Whatever the case, a child or the children are now exposed to a situation of not having medical aid cover and possibly not having the benefit of private healthcare. As difficult as it sounds, the problem is that divorce can be messy and situations like these are often used as a power play at times. In these instances a compromise has to be reached – either one of the parents have to join a medical aid as the main member and include the child as a dependent.
Medical Aid After Death of Parents
Whereas there are options with divorce, death poses new problems. Firstly, it is important to speak to the individual medical scheme. Open and restricted medical aids may have different policies with regards to certain situations. With some schemes and employers, in the event of the death of the main member, the spouse who was an adult dependent now becomes the main members. This ensures that cover continues. However, if both main member and spouse are deceased or the spouse was not on the medical aid, then the eldest child dependent technically becomes the main member. Younger children then stay on as child dependents.
However, problems may arise when a child did not have previous medical cover or the cover fell away after death of the main member, and now the guardian wants to have the child covered. The guardian may not be able to afford cover for themselves but there are allowances for the child to afford medical aid cover from the family trust. Or the guardian does not want to include the child on their own medical aid or that of their partner for certain reasons. Whatever the case, the child has no cover and there is no adult willing to stand as the main member. It can be a difficult situation – sometimes one partner who has taken responsibility for a child is on the medical aid of another person who does not want to include the child.
Higher Medical Expenses
Sometimes a parent may opt for a cheaper medical aid for themselves but want a more expensive cover for their child only. The child may have greater medical needs that requires better cover. Or the parent cannot afford a better medical aid for all their dependents except for one child, possibly by receiving higher maintenance for the specific child. Whatever the case, the child (if under 18 years) cannot be on a medical aid on their own. Trying to cover a child on two medical aids in an attempt to get more cover is not practical and neither is it legal. In South Africa, it is law that a person can only belong to one medical at any one time. It is not about what you can afford. If you are caught being on two schemes at the same time, you could be suspended from both.
The bottom line is that there are situations where a medical aid for children only is necessary but schemes have their rules for good reasons. In divorce especially, parents need to be practical and consider viable alternatives rather than bickering over responsibility. A child without medical aid is essentially at the mercy of the public health system unless the parents can fork out large amounts of money in the event of private hospitalisation. And these private hospitals often want a large deposit upfront. If there is no medical aid, the child is sent to a public hospital. Such a situation could be avoided by parents sometimes compromising and looking beyond their personal differences after a divorce.