Medical Aid Waiting Periods
When you join or move medical schemes, the new scheme may impose a waiting period before you can claim. It's a normal part of underwriting — but there are limits, exceptions and PMB protections you should know about.
Why waiting periods exist
Medical schemes are a shared pool. If members could join, claim a large amount immediately and leave, the pool would collapse and everyone's contributions would rise. Waiting periods protect existing members from this kind of risk.
The two types of waiting period
There are two — and only two — types of waiting period a scheme is allowed to impose.
General waiting period: Up to 3 months. You pay contributions but can't claim anything, except for Prescribed Minimum Benefits (PMBs).
Condition-specific waiting period: Up to 12 months. Applies only to pre-existing conditions you had in the 12 months before applying. You can still claim for everything else during this time.
When can a scheme apply each one?
If you've never had medical scheme cover before, both can apply.
If you're moving from one scheme to another after at least two years of continuous cover, only the 3-month general waiting period can apply — not the condition-specific one.
If your gap between schemes is less than 90 days and you had cover for more than two years, no waiting periods may apply at all.
If you're joining within 30 days of an employer-mandated scheme change, no waiting periods may apply.
Your PMB safety net
Prescribed Minimum Benefits are a list of around 270 medical conditions plus emergencies that every scheme must cover — even during a waiting period. This includes most cancers, all medical emergencies, HIV/AIDS treatment, and many chronic conditions.
So if you're in your waiting period and have a heart attack, the scheme must still cover the costs (within PMB rules). The same goes for an emergency caesarean or treatment for a covered chronic condition.
What counts as a pre-existing condition?
A condition is considered pre-existing if you had symptoms, received treatment, or were advised about it in the 12 months before applying. Schemes don't look at your entire medical history — only that 12-month window.