Waiting Periods/Exclusions

A waiting period means you have joined the scheme and you are paying contributions, but certain benefits are not available immediately. Under South African medical scheme rules, a scheme may apply a general waiting period of up to 3 months and, in certain cases, a condition-specific waiting period of up to 12 months for a pre-existing condition.

This catches people off guard because it feels unfair at first glance. You are paying, after all. But waiting periods are part of the underwriting rules that schemes are allowed to apply in certain circumstances, especially where there has been a break in cover or where a person joins with an existing condition. The key thing is to understand the rules before joining, not only when you need treatment.

A useful point to remember is that PMB rules are different. The Council for Medical Schemes states that no restrictions, waiting periods, or exclusions may be applied in respect of PMBs when the required services are obtained from designated service providers, subject to scheme rules and protocols. That is why the exact details matter.

Important points:

• A waiting period delays access to certain benefits
• A general waiting period can be up to 3 months
• A condition-specific waiting period can be up to 12 months for a pre-existing condition
• PMBs are treated differently under the law when scheme rules are met and DSPs are used where required
• This is one of the main reasons proper advice before joining really matters

A broker from Universal Cover can explain waiting periods clearly and give financial advice before you join, so there are fewer surprises later.