When joining a medical scheme with an existing condition, and if you have never had medical aid cover before (or at least not in the last five years) you most likely will have a waiting period for treatment of that condition. For many this can be an added stress, as they are paying for medical aid, as well as the treatment for their existing condition. But what is this waiting period?
|Medical aid scheme||Waiting period|
|Discovery Health||12 months|
|Momentum Health||12 months|
|Spectramed||3 months standard waiting period, but underwriting will determine exact waiting period for a specific condition|
While Spectramed stated they have a three month standard waiting period, the call centre agent emphasised that the actual waiting period will be determined during the underwriting process. As such, you will have to complete and submit the membership forms, and only once the underwriting process is completed will you know what your exclusion period for treatment of your existing condition will be. At this point you can agree to the waiting period, or refuse, in which case your membership application will be cancelled.
It appears that the industry standard for exclusion of an existing condition is 12 months. This means that if you have not had medical aid cover within the past five years, and you have a chronic condition, or any medical condition, upon becoming a member, the treatment for this condition will not be covered by the medical aid for 12 months.
It is generally thought that as a younger person you will be a lower risk for a medical aid, or any other form of insurance. By joining a medical aid at a younger age, you can hopefully miss any exclusions for existing conditions, as you become a member before you are afflicted with a chronic condition. If you are unfortunate enough to be diagnosed with a chronic condition prior to getting medical aid cover, you will have to fund the first year’s treatment out of pocket, before your medical aid will cover any related expenses.
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Until next time,
The MoneyShop.co.za Team
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