What underwriting will the Scheme impose?

Late Joiner Penalty

This is a penalty placed on an applicant or the adult dependant of an applicant who, at the date of application for membership, is 35 years of age or older, but excludes any beneficiary who had cover with one or more medical schemes as from a date preceding 1 April 2001, without a break in coverage exceeding three consecutive months since 1 April 2001.

Three-month General Waiting Period

The scheme may impose a waiting period if a member and/or dependants were not members of a medical scheme in the 90 days prior to the date of joining the scheme.
If a member has been a member of a medical scheme for a continuous period of more than 24 months and terminated their membership less than 90 days prior to the date of joining the new scheme, then the following waiting period may be imposed:

  • A general waiting period of up to 3 months is imposed, excluding any condition within the Prescribed Minimum Benefits.

Twelve-month Pre-existing Condition Waiting Period

If a member has been a member of a medical scheme for a continuous period of less than 24 months and terminated their membership less than 90 days prior to the date of joining the new scheme, then the following waiting period may be imposed:

  • A condition specific waiting period of up to 12 months based on a pre-existing medical condition

Fedhealth membership acceptance

When a member joins the scheme, they will be underwritten according to the group decision in place at the time of the member joining. Additional dependants may be subject to underwriting, should they join at a later stage, and individual criteria would apply.