Can A Medical Scheme Reject Your Application?

So you’re thinking of joining a new medical aid scheme but you’re worried whether they’ll accept you.
  • Maybe you have a history of a serious illness?
  • Maybe you suffer from a chronic illness which requires expensive medication?
  • Maybe you have just been diagnosed with a life threatening illness?
Usually the people asking these questions have never been on a medical aid before. They’ve seen a doctor and have been diagnosed with a serious illness and now a medical aid moves from a ‘nice to have’ to a ‘must have’.

Let us put your mind at ease.

All open medical schemes must accept your application.
It doesn’t matter whether you’re on death’s doorstep. It doesn’t matter whether you’ve just turned 105 and realise it’s all downhill from now on. They cannot refuse your membership!

But this doesn’t mean they cannot penalise you with:
  • Waiting periods, or
  • Late joiner penalties
How do I know whether a scheme is open or not?

Two types of schemes exist:
  1. Open schemes
  2. Restricted schemes
An open scheme is one where any member of the public is free to join. An example of this type of scheme is Discovery Health or Spectramed.

A restricted scheme, on the other hand, is one where only members of a certain profession, or employees of a certain employer, can join.
Examples are the government employees medical scheme (GEMS) or (BankMed) for bank employees.

The take away is that no Open Medical Scheme in South Africa can reject your application, but as we have mentioned in the past, waiting periods and late-joiner penalties can apply.

Thanks for taking the time to read this article. Are you in the market for a quote? Apply now