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Medical Aid Schemes – Waiting Periods

Medical Aid

Medical Aid Schemes – Waiting Periods

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Are you looking to join a Medical Aid Scheme? If so, it is important that you understand whether or not you are likely to be hit with a waiting period before you can claim benefits.

What is a waiting period?

Medical aid schemes are allowed to impose waiting periods if the member has never been part of a medical scheme, or if he/she has a break in membership from any medical scheme for a significant period of time.

There are two waiting periods that are usually imposed:

  • A 3 month general waiting period; and
  • A 12 month condition specific waiting period

A general waiting period is a period during which a member/beneficiary of a medical scheme cannot claim any benefits.

A condition specific waiting period is one on which a member or beneficiary of a medical scheme cannot claim benefits in respect of a condition for which medical advice, diagnosis, care or treatment was recommended or received within the 12 months leading up to the date of application to a new medical scheme.

Note: A waiting period cannot be imposed when a member registers a child dependant on the scheme or when a member changes options within the same medical scheme. In these cases, cover must begin immediately.

Waiting periods will be applicable when:

ReasonWaiting period which could apply
You were not a member/beneficiary of any medical scheme for more than 90 days before application to the medical scheme3 month general waiting period

12 month condition specific waiting period (if applicable as per above explanation)
You were a member/beneficiary of any medical scheme in the 90 days before application to a new medical scheme, but have not been a member/beneficiary of any medical scheme for a continuous period of 24 months.
12 month condition specific waiting period (if applicable as per above explanation)

You were a member/beneficiary of any medical scheme in the 90 days before application to a new medical scheme and have been a member/beneficiary of any medical scheme for a continuous period of more than 24 months



3 month general waiting period

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Shameer Chothia is currently an Employee Benefits Consultant at Momentum Consultant and Actuaries. He is the chairman of the Rhine Stone Body Corporate and the Founder and Head Financial Coach at LMS Financial Coaching. Shameer is deeply passionate about financial literacy and education. He truly believes that there is duty to empower people with education, which makes a difference in their everyday lives. To achieve this, he founded LMS, actively changing lives by empowering people with financial knowledge

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