Medical aids with no waiting period in South Africa are quite difficult schemes to come across. Applying for a medical aid with a short waiting period is probably easier. However there are some clauses that qualify scheme holders to get immediate access to their medical aid benefits.
What is a medical aid waiting period?
A medical aid waiting period is an amount of time in which a beneficiary has to pay the normal monthly contribution. But cannot yet make a claim for any of the scheme’s benefits.
Medical aids can enforce this waiting period by law.
There are two main types of waiting period:
Firstly a general waiting period that lasts up to three months. During this time, neither you nor your dependents may claim from the medical aid. Aside from the prescribed minimum benefits. When choosing a medical aid scheme look for one that includes these benefits.
Secondly a condition-specific waiting period lasting up to twelve months. If a member has pre-existing medical conditions, the beneficiary is not entitled to medical aid benefits. For a condition for care, treatment, advice or diagnosis that was received or recommended within a period of 12 months. Ending on the date the beneficiary made the application for membership to the medical aid scheme.
So this condition applies to both you and your dependents.
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When can a waiting period for medical aids be applied?
In accordance with the Medical Aid Schemes Act of South Africa, a medical aid company may impose a waiting period of three months. In the following circumstances:
- If the applicant has not been a member of the medical aid scheme for a time period of no less than 90 before that date of the application.
- Or if the applicant was a previous beneficiary of a medical aid scheme for up to 24 months. Ending less than 90 days before the date of the application.
- If the applicant has had previous medical aid coverage for over 24 months. But chooses to join another medical aid scheme selectively, on a voluntary basis.
When does a waiting period not apply?
Although there are not many medical aids with no waiting period, there are circumstances in which a waiting period will not apply:
- For a child dependent who is born during the membership period
- For members who change from one benefit option to a different benefit option. Within the same medical aid scheme. This does not apply if the member is still subject to the waiting period on their current benefit option. If this is the case, the remaining period will apply when the member changes benefit options.
- If an employer chooses to terminate or change to medical aid scheme of its employers. This transfer should take place in the beginning of the financial year, or the medical scheme must be given reasonable notice. In the other words, if the change to a different medical aid is not the choice of the employee (but rather the choice of the employer) the waiting period will not apply.
Tips to avoid a long waiting period
Medical aids impose harsher waiting periods on people who join having been part of another scheme in the past.
Longer waiting periods are also given to people who have had a break between memberships.
This is to prevent people from only joining a medical aid scheme when they are sick and need the benefits.
To avoid these longer waiting periods, join a medical aid as soon as you can afford to do so. And ask your employer if they will assist you with medical aid payments.
Don’t wait until you fall ill before joining medical aid as it is actually a preventative measure.
If you change medical aid schemes voluntarily before the waiting period (particularly a condition-specific 12 month waiting period) is up. The new medical aid scheme can impose its new waiting periods.
As well as adding the remaining amount of time left on the waiting period from your previous scheme.
So rather than looking online for medical aids with no waiting period choose the schemes with a short waiting period.