Medical · 4 min read
How medical aid waiting periods work in South Africa
The two waiting periods every new SA medical aid member faces — and when schemes are allowed to apply them.
Quick summary
South African medical schemes can apply two waiting periods to new members: a 3-month general waiting period during which no claims pay, and a 12-month condition-specific waiting period for pre-existing conditions. PMBs are protected.
Best for
- ·Anyone switching schemes
- ·First-time medical aid buyers
- ·Members adding dependants
Watch out for
- ·Cancelling old cover before new cover starts — gap creates new waiting periods
- ·Not disclosing chronic conditions at application
- ·Underestimating gap cover during the waiting window
Frequent questions
- Can a medical scheme refuse to admit me in South Africa?
- No. Open schemes (Discovery, Bonitas, Momentum, Fedhealth, etc.) must accept any applicant regardless of health. They can apply waiting periods and late joiner penalties, but they cannot decline you outright.
- What is a late joiner penalty?
- If you join medical aid for the first time after age 35, the scheme can add a permanent loading of 5–75% to your contribution depending on how late you joined and your prior cover history.
- Should I get gap cover during the waiting period?
- Gap cover doesn't replace medical aid — it only tops up shortfalls on claims your medical aid has already paid. During a waiting period the medical aid isn't paying, so gap cover won't help. Consider a hospital cash plan instead.
The 3-month general waiting period
The scheme can refuse to pay for any non-PMB claim during the first 3 months. You still pay full contributions. Prescribed Minimum Benefits (270 conditions including most cancers, HIV and emergencies) must be covered from day one by law.
The 12-month condition-specific waiting period
If you have a pre-existing condition (the scheme can ask 12 months back), they can decline cover for that specific condition for 12 months. Asthma, diabetes, hypertension — the usual suspects. Again, PMB cover for that condition cannot be excluded.
When waiting periods don't apply
Late joiner penalties apply differently. If you're moving directly from another medical aid with continuous cover, the new scheme can only apply a 3-month general waiting period (not 12 months condition-specific) provided you joined the previous scheme within the last 90 days.
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