Medical Aid, Medical insurance admission for South Africa

Medical Aid Medical insurance admission for South Africa
Medical Aid Medical insurance admission for South Africa

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:

  1. A 3 month general waiting period
  2. A 12 month condition-specific waiting period, or
  3. A waiting period on certain PMB’s (Prescribed Minimum Benefits)
  4. 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

Except:

  1. A child born to a member.
  2. Change between benefit options.
  3. 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

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