Waiting Periods & Health Loadings

  • A medical scheme may impose a general waiting period of up to three months upon a new member and the member's dependant(s) before such member or dependant(s) is entitled to claim any benefits.
  • A general waiting periods must not be imposed on a member if, at the date of application, the member has been a member or a dependant of a member of one or more medical schemes for a continuous period of two years or more.
  • A medical scheme may impose a specific waiting period of no more than nine months for any costs of confinement due to pregnancy.

 

  • Where a pre-existing sickness condition exits in respect of an applicant or a dependant, a medical scheme may impose a condition-specific waiting period for not more than twelve months on the applicant or on a dependant or both from the date of coverage, Provided that:
  1. No waiting period may be applied to any treatment or diagnostic procedure covered within the prescribed minimum benefits; and
  2. No pre-existing sickness condition exclusion may be applied to any member or dependant who is moving between benefit options in the same medical scheme.

 

  • A medical scheme may apply premium penalties to an applicant or dependant of a late joiner and such penalties must be applied only to the portion of the contribution related to the member or any dependant who qualifies for the late joiner penalties.

 

Number of years an applicant was not a memberof a medical scheme after the age 35 Maximum Penalty
1- 4 years 5 % x contribution
5- 14 years 25 % x contribution
15- 24years 50 % x contribution
25+ years 75 % x contribution

 

   

 

 

 

  • Any years of creditable coverage which can be demonstrated by the applicant or his or her dependent shall be subtracted from his or her current age in determining the applicable penalty.
  • Late joiner penalties may continue to be applied upon transfer of the member or adult dependant to other medical schemes.

 

For more information contact us