Waiting periods when you join a medical scheme.
Medical Schemes can apply waiting periods when you join a scheme, please see below for which waiting period would apply to you.
Applicants to a medical scheme can be divided into 3 categories…
Category A
Applicants that have had no previous medical cover (cover in a registered SA medical scheme) OR Applicants that have had a more than 90 day break since leaving their previous medical scheme.
The medical scheme may:
- Impose a 3 month general waiting period.
- Impose a 12 month condition specific waiting period.
- Impose a late joiner penalty
Prescribed minimum benefits are not available to these members.
Category B
Applicants that have had less than 2 years previous medical cover and have applied within 90 days since the termination date from their previous scheme.
The medical scheme may:
- NOT impose a 3 month general waiting period.
- Impose a 12 month condition specific waiting period for new conditions that occured within the last 12 months.
- Impose the balance of a condition specific or general waiting period that existed on the previous medical scheme.
- Impose a late joiner penalty.
Prescribed Minimum Benefits are available to these members.
Category C
Applicants that have had 2 years or more previous cover and have applied within 90 days since the termination date from their previous scheme.
The medical scheme may:
- Impose a 3 month general waiting period.
- NOT impose a 12 month condition specific waiting period.
- Impose a late joiner penalty.
Prescribed minimum benefits are available to these applicants.
PREGNANCY WAITING PERIOD
Category A
A 12 month condition specific waiting period may be applied.
Category B
The balance of a pregnancy waiting period may be applied; or a 12 month waiting period if the client fell pregnant within 12 months prior to application date.
Category C
A 3 month general waiting period can be imposed.
Please remember to keep this in mind when applying for medical scheme cover.