Waiting periods when you join your South African medical scheme.

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.

Waiting periods when you join your South African medical scheme. was last modified: March 28th, 2018 by Kenny Williamson

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