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The below table looks at five of the big medical aid providers in South Africa, and their standard waiting period for new members with existing conditions: 

Medical aid scheme Waiting period
Discovery Health 12 months
Bonitas 12 months
Momentum Health 12 months
Bestmed 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