The short version
- Registered schemes must accept you. Your health can't be used to refuse you or to set your contribution.
- The longest a scheme can make you wait for a pre-existing condition is 12 months. It can't exclude a condition for good.
- If you move from another scheme with a break of 90 days or less, the waiting periods are shorter or fall away.
- If you join after 35 with years of no cover, a late-joiner penalty can be added to your contribution for as long as you stay a member.
- Always disclose. Hiding a condition on your application lets the scheme refuse related claims or cancel your membership.
Waiting periods, by your cover history
| Your situation | General waiting period | Condition-specific waiting period | PMBs paid during the wait? |
|---|---|---|---|
| No medical scheme cover in the last 90 days, or never a member | Up to 3 months | Up to 12 months | Not required |
| Moving from another scheme after less than 2 years' membership | Only any unexpired period from your old scheme | Up to 12 months | Yes |
| Moving from another scheme after 2 years or more | Up to 3 months | None | Yes |
| Your employer moves the whole group to a new scheme | Only any unexpired period | Only any unexpired period | Yes |
| Changing option within the same scheme | None, unless you're still serving one | None, unless you're still serving one | Yes |
| Baby born while you're a member and registered in time | None | None | Yes |
Source: section 29A of the Medical Schemes Act 131 of 1998. "In time" means within the period in your scheme's rules, usually 30 days from birth.
The late-joiner penalty
Applies only if you join after age 35 and have years without medical scheme cover. It's a percentage added to the risk part of your contribution, for as long as you stay a member.
| Years without cover after age 35 | Maximum penalty |
|---|---|
| 1 to 4 years | 5% |
| 5 to 14 years | 25% |
| 15 to 24 years | 50% |
| 25 years or more | 75% |
Source: Regulation 13 of the Medical Schemes Act regulations. Earlier medical scheme membership counts in your favour, so bring proof of previous cover when you apply.
If you already manage a chronic condition
Chronic medicine for the Chronic Disease List conditions must be covered on every option once any waiting period ends. Some options cover more conditions than that.
- 27 Chronic Disease List conditions every registered option must cover
- Options in our 2026 data cover between 26 and 75 chronic conditions in total
- Widest list: CompCare SuperCare — Covers 75 chronic conditions (27 PMB plus 48 additional).
What counts as pre-existing
A condition you got medical advice, a diagnosis, care or treatment for in the 12 months before you applied. The application form asks about this, and the scheme may ask your doctor for reports.
Cancer, HIV and heart conditions
These can't be excluded for good either. If you're joining with no recent cover, the scheme can apply the condition-specific waiting period of up to 12 months. After that, the condition is covered under your option's normal benefits. HIV, many cancers and most heart conditions are Prescribed Minimum Benefits, so every option must pay for a defined level of treatment.
Emergencies during a waiting period
An emergency is a Prescribed Minimum Benefit. If you came across from another scheme within 90 days, your new scheme must pay for it during any waiting period. If you had no cover in the previous 90 days, the law allows the scheme not to pay PMBs, including emergencies, while you serve the waiting period. That's the strongest reason not to let cover lapse.
How to get the shortest wait
- Don't let cover lapse for more than 90 days when you change jobs or schemes.
- Get a membership certificate from your old scheme showing your dates of cover.
- Disclose every condition on the application, even if it's under control.
- Ask the new scheme to confirm in writing which waiting periods apply to you and each dependant.
- If you're joining through an employer, ask whether waiting periods are waived for the group.
Questions people ask
Can a medical aid refuse me because of a pre-existing condition?
No. Registered medical schemes in South Africa must accept any applicant and can't set your contribution by your health. They can apply waiting periods and, if you're over 35 with no prior cover, a late-joiner penalty.
Can a pre-existing condition be excluded forever?
No. The longest condition-specific waiting period allowed is 12 months. After that the scheme must cover the condition under your option's normal benefits.
How can I reduce the waiting period?
Keep your cover continuous. If you move from another scheme with a break of 90 days or less, the waiting periods are shorter or fall away, and PMBs must be paid throughout. Employer groups can also negotiate waived waiting periods.
What happens if I don't disclose a condition?
The scheme can refuse related claims and may cancel your membership. Disclose everything, then ask for the waiting periods in writing.
Does a waiting period apply to my newborn?
No, as long as the baby is born while you're a member and you register them within the time your scheme's rules allow, usually 30 days.
Related on Medical Aid Online
Sources
This guide is general information, not financial or medical advice. Medical Aid Online is not a medical scheme. Scheme rules and benefits change every year, so check the scheme's own rules and brochure before you decide.
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