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:
- General waiting period: This is usually three months in length, depending on the medical aid scheme you join. During this time, you have to pay your normal monthly contributions, but you aren’t entitled to claim any benefits, except in certain instances with claims relating to PMBs.
- A secondary waiting period: This is usually around 12 months long and is related specifically to treatment for any pre-existing conditions you had when you joined the scheme.
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. Younger and healthier members generally contribute for a reasonable period before they make major claims, and during this time, they subsidise 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.
