Leave It Too Late And Your Medical Aid Will Bench You

Are you currently on a medical aid? If the answer is ‘No’ but you are planning to join a medical aid scheme sometime soon, you might want to consider reading this article, because you could find yourself benched.

The first question we need to get out of the way is the following - Is a Medical Scheme allowed to impose waiting periods at application stage?

The answer is ‘Yes’, The Medical Schemes Act makes a provision for this. By law, Medical Schemes are allowed to impose certain limited waiting periods, but the good news is that there are only two.

What types of waiting periods would you need to sit out? A Medical Scheme can impose the following waiting periods:-
  • A three-month general waiting period, and
  • A twelve-month condition specific waiting period
During the three-month general waiting period, you will not be entitled to claim any benefits, but you will be obliged to pay full premiums during that time. So, basically you are going to sit for 90 days, on a scheme, but you will be unable to claim.

During the twelve-month condition specific waiting period you will not be entitled to claim benefits for a condition, for which medical advice, diagnosis, care or treatment was recommended or received. But again, you will pay full premiums.

“Jeez this seems a little unfair!” we hear you saying. “Why are they allowed to do that?”

It really is in place to protect the other existing members, on the scheme. While a Medical Scheme cannot refuse anyone cover, they need the right to be able to bench new members, who might be looking to jump onto the scheme, in order to claim and then possibly leave.

And it does make sense. From a schemes perspective, they will be thinking - this person hasn’t been on a scheme before, we need to accept them, but we can’t take the risk of them joining the scheme and in week two they start claiming from us. How do we go about protecting our existing members from this?

And they do that by imposing the restrictions, mentioned above. It’s a great thing for the members on the scheme, not such a good thing for people looking to join the scheme.

The take home is the following - don’t wait too long to join a medical aid scheme. They are going to make you sit out 3 months if you haven’t been on a scheme before, and should you have a condition of sorts, prior to sending in your application form, they are certainly going to impose a 12 month exclusion pertaining to that condition.

Make sure you get onto a Medical Scheme while you are young and healthy.

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The I-Hound