Healthcare in South Africa: no treaty, a medical aid that may not refuse you, and the waiting periods of three and twelve months
South Africa is not on the list of treaty countries: no S1, no CAK, your Dutch basic insurance stops on deregistration and the visa asks for proof of medical cover. A registered open medical aid may not refuse you, but may impose a general waiting period of three months and a condition-specific waiting period of twelve months, and a late-joiner penalty for whoever joins at 35 or older. The prescribed minimum benefits are the safety net.
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No, your Dutch health insurance does not come with you to South Africa and no treaty right replaces it: the country is not on the list of treaty countries of the foreign scheme, so no S1, no CAK contribution. What it costs is set by the medical aid you take out yourself, and you take it out before departure, because the retired person visa asks for proof of medical cover. The find is at the Council for Medical Schemes, the regulator: a registered open medical aid may not refuse you and may not charge a higher contribution for the same plan because of your age or health. The trap is what it may do: a general waiting period of three months, a waiting period of twelve months for existing conditions and a late-joiner penalty for whoever becomes a member for the first time at 35 or older.
Why does the Dutch cover stop completely?
The foreign scheme applies to whoever receives a statutory pension or benefit from the Netherlands and lives in a treaty country; the CAK runs it and collects a treaty contribution for it. The list of treaty countries runs from Belgium to Switzerland, with Cape Verde, Morocco, Tunisia and Turkey in between, but South Africa is not on it. So your basic insurance ends on the day of deregistration and the CAK plays no part. What replaces it you arrange yourself, and the step-by-step plan puts that in the phase closing the Netherlands, because the visa file already wants to see the proof.
Medical aid or health insurance, what is the difference?
The regulator draws the distinction sharply. A medical aid (medical scheme) pays your healthcare costs: GP, specialist, hospital, medicine. A health insurance pays a fixed amount per day or a sum when a specified event occurs, and a hospitalisation policy may not cover medical expenses. For whoever settles, the medical aid is therefore the system, and the health insurance at most a supplement. The best-known supplement is called gap cover: a policy that covers the difference between what a provider charges and what the scheme pays, and the only health policy the regulator allows to require membership of a medical aid.
| Rule | What the regulator says |
|---|---|
| Admission | an open scheme must enrol everyone who can pay the contribution |
| General waiting period | at most 3 months, contributions due, no claims except PMB exceptions |
| Condition-specific waiting period | at most 12 months for conditions known at application |
| Late-joiner penalty | possible for whoever joins at 35 or older |
| Contribution | community rating: no difference by age or health, only by income and number of dependants |
| Prescribed minimum benefits | emergency care, 271 conditions and 26 chronic diseases, always covered |
What are the prescribed minimum benefits?
The Medical Schemes Act obliges every scheme to pay for the diagnosis, treatment and care of any emergency medical condition, of a list of 271 conditions (the diagnosis treatment pairs) and of 26 chronic diseases on the chronic disease list, whichever plan you chose and even when your annual budget has run out. For that care the scheme appoints designated service providers: hospitals, doctors and pharmacies that are its first choice. If you go to another, the scheme may ask a co-payment, as a percentage or as the difference between the designated provider's tariff and yours. So choose your GP and hospital with the policy in hand.
The condition-specific waiting period of twelve months applies only to what was declared at application or treated in the twelve months before it. A scheme may not exclude anything that was not diagnosed or treated in that period, and once the twelve months have lapsed it is liable for the condition. So fill in the application completely; concealing costs more than waiting.
What exactly does the visa ask?
Home Affairs names proof of medical cover as a fixed part of the file for the retired person visa. For the exchange visa the requirement is worded more precisely: cover for the whole period with a medical scheme registered under the Medical Schemes Act. Whoever submits the application in The Hague therefore has the policy before the appointment, and the medical aid starts running while you still live in the Netherlands; the three-month waiting period then already runs. What the other visa requirements look like is in the visa routes.
How do I put the contribution in my budget?
Community rating means the contribution for a plan is the same for a thirty-year-old and an eighty-year-old; the difference lies in the plan you choose, in the late-joiner penalty if you join at 35 or older without earlier membership, and in the co-payments outside the network. The cost indication works with the range of contributions; the regulator publishes no tariffs, because each scheme sets its own. For the journey there and the first weeks the usual applies: the policy runs from the start date, the membership number travels with your passport, and your scheme's emergency number is in your phone before landing.
In Vertrekklaar this is phase 3 of 5 of the journey, step 3.1: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to South Africa or go straight to step 3.1 in the open plan.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- NederlandWereldwijd — the foreign scheme and the list of treaty countries, which South Africa is not on — nederlandwereldwijd.nl
- CAK — the foreign scheme: treaty beneficiaries with a statutory pension or benefit in a treaty country — hetcak.nl
- Department of Home Affairs — the visa types: proof of medical cover for the retired person visa, and a medical scheme under the Medical Schemes Act for the exchange visa — dha.gov.za
- Council for Medical Schemes — medical aid versus health insurance: open enrolment, the waiting periods of three and twelve months, the late-joiner penalty from 35 and community rating — medicalschemes.co.za
- Council for Medical Schemes — the prescribed minimum benefits: emergency care, 271 conditions, 26 chronic diseases and the designated service providers — medicalschemes.co.za
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