WAITING PERIODS, EXCLUSIONS AND PENALTIES

▶ 3 MONTHS If you were a member of a scheme for more than two consecutive years without a break of more than 90 days between schemes, the new scheme can require a three-month waiting period and charge a latejoiner fee (see below). You’ll be covered for prescribed minimum benefits but won’t have access to full benefits. ▶ 12 MONTHS If you were a member of a scheme for less than two years without a break of 90 days between funds, the new scheme can require a 12-month condition-specific and procedure-specific waiting period. For example, if you had a hip operation in the 12 months leading up to your application, the new fund can require exclusions for the first 12 months of your new membership for any hip-related conditions. The scheme might also charge a late-joiner fee (see below). In such a case the three-month waiting period doesn’t apply. ▶ PENALTIES FOR JOINING LATE These can be charged if you’re 35 or older and either joining a medical scheme for the first time or left your previous scheme longer than 90 days ago. The penalty is calculated on a sliding scale. First, the total number of membership years (since you were 21) is subtracted from your age. The penalty fee is then charged according to the following table: if the difference in years is between 35 and 39, the penalty is 5% of your monthly contribution; between 40 and 49 the penalty is 25%; between 50 and 59 it’s 50%; and for 60 or more the penalty is a whopping 75%. ▶ FOR EXAMPLE If you’re 45 and belonged to a medical scheme for 10 years but you’ve been without one for a year and want to join again: 45 – 10 = 35. According to the sliding scale your penalty will be 5%, so if your monthly contribution would’ve been R525 it will now be R551,25 to include a 5% penalty fee. The penalty is only applied to the risk section of your contribution, not the total (which can include a savings account). If, for instance, you have only a hospital plan, which doesn’t include a savings account, the above calculation will be applicable.