The short answer: appoint an advisor on your medical aid and gap cover now, while nothing is wrong. Your scheme discusses your membership only with you, someone you have authorised, or the broker appointed on it. When a claim comes back short, an admission needs approval or a diagnosis changes what you need, the advisor who is already on record can act that day. Your contribution is the same either way.
Why now, and not when something goes wrong
Most people look for help in the week they need it: in hospital, with a pre-authorisation pending, or holding a statement that does not add up. That is the worst week to start. The appointment has to be signed and processed by the scheme before an advisor can ask it anything about your membership.
Appointed now, the advisor already has your plan, your household and your history when the moment comes. The help is in place before you need it, the same reason you have medical aid at all.
The moments it is for
- A planned admission. Pre-authorisation, the hospital on your plan's network, and what the scheme will and will not pay.
- A claim paid short. Finding out why, and what to ask the scheme.
- A new diagnosis. Registering a chronic condition, and what your plan covers for it.
- A gap cover claim. Gap cover generally pays only where your medical aid has paid towards a hospital account, so the two have to be read together.
- A change in your life. A baby, a marriage, retirement or coming home from abroad. Some carry rules with a cost, such as waiting periods when you switch, or a late-joiner penalty if you join after 35.
And once a year, when schemes publish next year's contributions and benefits, the advisor checks whether your plan still fits before the deadline to change it.
It does not cost you more
Your contribution is the same whether or not you have a broker. If you have one, the scheme pays their fee out of contributions, capped by regulation under the Medical Schemes Act: up to 3% of contributions plus VAT, to a monthly maximum the Council for Medical Schemes adjusts each January.
It does not change your cover
Appointing an advisor does not change your plan, your contribution, your waiting periods or your benefits. It changes only who looks after your membership. You sign the scheme's appointment form, and you can end or change the appointment whenever you choose.
Gap cover is appointed separately
Gap cover is a short-term insurance policy, not part of your medical aid, so an advisor is appointed on it separately. The advisor's commission is paid by the insurer, and by law it must be disclosed to you.
Questions people ask
Why appoint a medical aid advisor before I need one?
Because your scheme discusses your membership only with you, someone you have authorised, or the broker appointed on it. If an advisor is already appointed when a claim is short-paid or an admission needs approval, they can act straight away. If not, the appointment has to be signed and processed first, at the moment you least want paperwork.
Does appointing a medical aid broker cost more?
No. Your contribution is the same whether or not you have a broker. If you have one, the scheme pays their fee out of contributions, capped by regulation at 3% of contributions (plus VAT), up to a monthly maximum the Council for Medical Schemes sets each year.
Does appointing a broker change my plan or cover?
No. Appointing or changing an advisor does not change your plan, your contribution, your waiting periods or your benefits. It only changes who looks after your membership.
How do I check who my broker is?
Ask your medical scheme who is listed as your broker. If someone is listed and you have not heard from them, you can appoint a different advisor at any time.
Does gap cover need an advisor too?
Gap cover is a separate insurance policy, so the advisor is appointed on it separately. The advisor's commission is paid by the insurer and must be disclosed to you.
Can I change my advisor later?
Yes. You can end or change the appointment whenever you choose, by telling your scheme or insurer.
Written by Eldon de Waal, CFA, the licensed advisor behind AURA. This page explains how broker appointments work. It is not advice about your own plan.