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So you’ve finally decided to get onto a private medical aid scheme. You figure if you get ill, you can’t run the risk of landing up in a government hospital. The problem is you aren’t 100% fighting fit anymore! Your back keeps playing up since that unfortunate mountain bike crash and you’ve developed hypertension. Is this going to be a problem when applying to become a new member of a private medical aid scheme?

In my last medical aid post I dealt with the 1st waiting period a medical aid scheme can impose on new members. I’ll provide the link to that blog post at the end of this article. Today I’m going to deal with the 2nd waiting period a medical aid scheme can slap you with, once your application’s been submitted.

It’s called a “condition-specific-waiting period” and this is what you need to know…

If you haven’t belonged to a registered South African medical aid scheme before, or you’ve allowed yourself a 90 day break since resigning from your previous medical aid scheme, the scheme you are applying to join can impose a 12-month-condition-specific-waiting period.

So what is a 12- month-condition-specific-waiting period?

It’s pretty simple. Any pre-existing health condition you have will be excluded for the first year of your membership. That means any medical costs associated with that excluded condition isn’t going to be paid by the scheme in the first year of your membership. Before your membership is activated, the scheme will highlight which conditions are going to be excluded and you will need to sign off an agreement.

Why would a medical aid scheme impose a waiting period like this?

It’s to protect the current membership pool. Imagine for a second they didn’t have a protective measure like this in place. Anyone needing costly triple bypass surgery could jump onto a scheme and hit them for a whack of cash in the first week of being a member. Then they could simply leave the scheme.

When else can a scheme impose the condition-specific-waiting period?

If you’ve belonged to a scheme for less than two years, a scheme can also impose the condition-specific waiting period but they need to cover Prescribed Minimum Benefits. If you’ve never heard the term Prescribed Minimum Benefits or PMB’s, check out my blog post. I’ll provide the link at the end of the article.

What happens if I leave a scheme to join a new scheme and I’m not yet through the condition-specific-waiting period?

That’s a good question. If your previous medical aid scheme placed a condition-specific-waiting-period on your membership and the waiting period didn’t expire at the date of ending your membership, the new scheme will make you wait out the remainder of the waiting period.

Remember you can Get Medical Aid Insurance at Insurance Fundi. Medical Aid cover is important insurance, so don’t delay getting onto a scheme today.

Until next time.

The InsuranceFundi Team