Admission Requirements for Medical Aid South Africa
All medical aid societies have an open door policy, so no medical aid can decline your application.
Therefore, the medical aid societies need to assess the risks they are taking on. To do so, they apply the following risk equalizers during the assessment process.
On admission to membership a scheme may impose:
- A 3 month general waiting period
- A 12 month condition-specific waiting period, or
- A waiting period on certain PMB’s (Prescribed Minimum Benefits)
- A Late Joiner’s Penalty –LJP’s
The late joiner’s penalties are applied after the age of 35 as follows:
|1-4 years (of break or not being insured):||5% loading on premium|
|5-14 years:||25% loading on premium|
|15-24 years:||50% loading on premium|
|25+ years:||75% loading on premium|
- A child born to a member.
- Change between benefit options.
- Termination of membership due to employment or employer changing schemes.
New Provisions Applicable to Waiting Period
|Category||3-Month General W/P||12-Month Condition W/P||Application to PMB|
|New applicants, or person not member for preceding 90 days||Yes||Yes||Yes|
|Applicants who were members for less than 2 years||No||Yes||No|
|Applicants who were members for more than 2 years||Yes||No||No|
|Change of benefits||No||No||N/A|
|Child-dependant born during period of membership||No||No||N/A|
|Involuntary transfer due to change of employment or employer changing scheme||No||No||N/A|