MEDICAL SCHEME UNDERWRITING

Medical Scheme’s may impose underwriting protocols when assessing an
application for membership and impose the following:

WAITING PERIODS
Medical Scheme’s are entitled to impose waiting periods on new members in
accordance with the Medical Scheme’s Act 131 of 1998.

Waiting periods protect other members of a Scheme, by ensuring that new
members cannot submit large claims shortly after joining a Scheme and once
these claims have been settled, continue to cancel their membership.

Two types of waiting periods may be applied:

• General waiting period (up to 3 months) A beneficiary will not be entitled to any benefits (even in some instances, not even PMB cover) during this period.

• Condition-specific waiting period (up to 12 months) During a condition-specific waiting period a beneficiary will not be able to submit any claims for medical advice, diagnosis, treatment or care to a Scheme for the specified medical condition.

LATE JOINER PENALTIES
On individuals who joins a Medical Scheme after the age of 35, a late joiner penalty may be applied. The penalties can be applied on anyone who have never been a member of a registered Medical Scheme or who have not belonged to a Medical Scheme for any period of time since April 2001.

Therefore depending on an individual’s age, a penalty of between 5% and 75% may be surcharged on your monthly contribution.

*The SpesBona team will assist and intervene where necessary where the underwriting is not performed in accordance with the Medical Scheme’s Act.