Waiting periods medical schemes – when you join your scheme in South Africa.

Waiting periods medical schemes.

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.

Waiting periods medical schemes – when you join your scheme in South Africa. was last modified: June 2nd, 2024 by Kenny Williamson

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