Joining a Medical Aid

Joining a medical aidJoining a medical aid scheme in South Africa may appear a daunting task but, in reality, it’s a straightforward process that just requires a little bit of planning.

We’ve provided a basic guide as to what general exclusions may be imposed and what supporting documents are required, so that you can download an application form and sign up in no time at all.

Your first task is finding a suitable medical aid scheme and plan, either personally or with the assistance of an independent medical aid broker.

Once you’ve identified a few sound options, simply request formal quotations from each scheme and compare their rules, exclusions and terms and conditions of service to ensure you make the best choice for you and any dependants you have.

General exclusions

Although open medical aid schemes are obliged to accept all South Africans, they're entitled to impose waiting periods and/or late joiner penalties and or exclusions where applicable.

Waiting periods

Consumers of medical aid in South Africa are governed by two forms of waiting period. There’s a general waiting period of up to three months, and a 12-month exclusion period for pre-existing medical conditions.

Over these periods, a member of a medical aid scheme is expected to pay monthly contributions but is not entitled to any benefits.

There are exceptions to the rule, such as the following:

  • the birth of a child during the waiting period
  • members upgrading or downgrading benefit options in-scheme
  • prescribed minimum benefits (PMBs) at designated service providers (DSPs). Where members have had previous cover for longer than 24 months. Here the member is entitled to certain benefits during the 3 months waiting period.

Late joiner penalties

Late joiner penalties are automatically added to contributions of people who are 35 years old and above and have not belonged to a medical aid scheme before or have had breaks in cover of longer than 90 days.

Supporting documents

All medical aid schemes will require a completed application form that includes your details, as well as certain supporting documents, when you sign up with them.

When you join a medical aid scheme, it’s vital you make full disclosure as to the age and status of your dependants and your medical and membership history.

In addition, medical aids may insist you furnish a formal medical report from your consulting physician or GP, or undergo a full examination in some cases. In either case, associated costs is sometimes paid by the scheme but not always.

Required documentation varies from scheme to scheme and can include:

  • a membership certificate, or sworn affidavit with commencement and termination dates, to prove you belonged to another medical aid scheme, to avoid a late joiner fee
  • a certified copy of the main member’s identity document, tax number and a bank statement, cancelled cheque or letter of confirmation from the bank
  •  copies of a marriage certificate or court order of a divorce settlement to prove a spousal or adult dependent relationship if required
  • birth certificates or adoption papers of all child dependants
  • proof of registration at a recognised tertiary institution for full-time students eligible for child rates with some schemes up to a certain age but not all schemes offer child rates from age 21

On receipt of a completed application form and supporting documents, a medical aid scheme will usually send out a "counter offer" letter, with an acceptance form detailing the terms and conditions of service. This is usually valid for 30 days but not always. Consult a medical aid broker and streamline the application process

You can streamline the process of joining a South African medical aid by consulting a medical aid broker. At IFC, we not only offer free consulting and after-sales services but do all the paperwork on your behalf. You can also download application forms for leading South African medical aids directly from our site.