When you join a medical aid scheme, you’ll usually be subjected to a waiting period, which is a period of time during which you won’t be covered if you need to make a medical claim. Medical aid waiting periods form part of South Africa’s Medical Schemes Act and are imposed to protect medical aid schemes. If these waiting periods weren’t in place, people might only be motivated to sign up for a medical scheme when they found out they were unwell, which would make it very hard to keep schemes financially viable.
What kinds of waiting periods are there?
There are two main types of waiting periods:
What is the duty of medical aid schemes?
Medical aid schemes in South Africa have a legal duty to be financially sound and this can only be achieved by balancing the risk profile of members. This is because younger and healthier members generally contribute for a reasonable period before they make major claims, and during this time they are subsidising the higher claims of older and more sickly members. This is cyclical, so that when these young healthy members get older, their claims are then subsidised by the younger and healthier members once again.
If people made large claims shortly after joining a scheme, and then cancelled their membership once they were well again, members would find they would have to pay much higher contributions, and the scheme may not be able to function financially at all.
DISCLAIMER: The information on this website is for educational purposes only, and is not intended as medical advice, diagnosis or treatment. If you are experiencing symptoms or need health advice, please consult a healthcare professional.