Underwriting

Late joiner Fees

Individuals & groups <10 employees

Individual members and adult dependants (including aged parents) above the age of 50 years, without historic medical scheme cover, or with a break in medical scheme cover of more than three consecutive months will be subject to a late joiner fee of 50%. The late joiner fee will be added to members’ contributions for the duration of the membership, from date of inception.

No late joiner fees will be applicable to individual members or adult dependents with historic medical scheme cover at the time of joining, without a break in cover of more than three consecutive months, and continuous membership of 2+ years.

Employer groups (>10 employees)

Late joiner fees will not apply to Employer group members.

General Waiting Periods

Individuals & Employer groups (<10 employees)

For individuals, and companies of <10 Principal Members, the general waiting period is three months. Other special dependants including grandchildren and siblings will have 6 months general waiting period and 12 months general waiting period for aged parents.

Employer groups (>10 employees)

For Groups with >10 Principal Members, the general waiting period is one month. Other special dependants including grandchildren and siblings will have 6 months general waiting period and 12 months general waiting period for aged parents.

Condition-Specific Waiting Periods

Individuals & Employer groups (<10 employees)

Pre-existing conditions will be excluded for a period of 12 months. The following condition- specific waiting periods will apply to all beneficiaries:

1.Oncology Waiting Periods

1. Pre-existing or newly diagnosed oncology will be excluded for the first 12 months, and aged parents’ diagnosis will be excluded for the first 24 months
2. Oncology detected after 12 months or 24 months for aged parents will be covered.

2.Optometry, Optical Benefits, and Dentistry Waiting Periods

1. Beneficiaries: 6 months
2. Aged parents: 24 months

3.Confinements (Pregnancy) Waiting Periods

1. Beneficiaries: 9 months

4.HIV/TB (claims relating to admissions only) Waiting Periods

1. All beneficiaries: 3 months

5.Major surgery, such as hernia repair, joint replacements & organ transplants

1. Beneficiaries: 12 months
2. Aged parents: 24 months

6.Cardiovascular and metabolic conditions

1. Including hypertension, non-insulin dependent diabetes mellitus, heart failure (stage I / II) & dyslipidaemia:
   1. Beneficiaries: 3 months
   2. Aged parents: 12 months

7.Neurosurgical Conditions

1. Beneficiaries: 12 months
2. Aged parents: 24 months

8.Cardiac Operations

1. Beneficiaries: 12 months
2. Aged parents: 24 months

9. Cerebral Palsy

1. All beneficiaries: 12 months

10. Newly started dialysis

1. Beneficiaries: 12 months
2. Aged parents: 24 months

11. Cover for the following pre-existing conditions will be excluded if disclosed at time of joining, or diagnosed within the first 12 months of membership (24 months for aged parents):

1. Renal failure / currently receiving renal dialysis
2. Multiple Sclerosis
3. Parkinson’s / Dementia / Alzheimer’s
4. Spinal cord conditions, such as paraplegia, quadriplegia
5. Stage III/IV Heart Failure
6. Insulin-dependent diabetes mellitus
7. Autoimmune conditions, such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis, Ulcerative Colitis, Crohn’s Disease
8. Pre-existing oncology
9. Cardiac dysrhythmia 

Employer groups (>10 employees without a break in cover)

The following condition-specific waiting periods will apply (exc. aged parents) to groups where employees have had medical cover for more than 2 years, without a break exceeding three consecutive months:

1.Dentistry and optical benefits

1. 3 months

2.Aged parent dependents with no previous cover

1. Waiting periods as applicable to Individuals will apply.

Employer groups (>10 employees with a break in previous cover)

Condition-specific waiting periods will apply to groups that had a break in medical scheme cover of more than three consecutive months:

1. Newly diagnosed oncology

1. Beneficiaries: 6 months
2. Aged parents: 24 months

2. Major surgery, such as hernia repair, joint replacements & organ transplants

1. Beneficiaries: 6 months
2. Aged parents: 24 months

3.Cardiovascular and metabolic conditions

1. Including hypertension, non-insulin dependent diabetes mellitus, heart failure (stage I / II) & dyslipidaemia:

   1. Beneficiaries: No waiting period

   2. Aged parents: 12 months

4.Optometry, Optical Benefits, and Dentistry Waiting Periods

1. Beneficiaries: 3 months
2. Aged parents: 24 months

5.HIV/TB (claims relating to admissions only) Waiting Periods

1. All beneficiaries: 3 months

6.Cover for the following pre-existing conditions will be excluded if disclosed at time of joining, or diagnosed within the first 12 months of membership (24 months for aged parents):

1. Renal failure / currently receiving renal dialysis
2. Multiple Sclerosis
3. Parkinson’s / Dementia / Alzheimer’s
4. Spinal cord conditions, such as paraplegia, quadriplegia
5. Stage III/IV Heart Failure
6. Insulin-dependent diabetes mellitus
7. Autoimmune conditions, such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis, Ulcerative Colitis, Crohn’s Disease
8. Pre-existing oncology