There is no one-size-fits-all, hard-and-fast, definitive answer to this question, principally because every case, each member or dependent, and every individual medical history is unique and differs from the next. It’s rare to find multiple identical applicants and therefore a single definitive answer, so it’s best to approach this question on a case-by-case basis if you want to be 100% clear. Moreover, familiarising yourself with the rules applicable to various medical schemes prior to choosing the one that you decide to join, is a complex and confusing exercise.
With the necessary addition of your own and your dependents’ circumstances, the picture and the answer to the question becomes even more intricate. Although most medical aids provide similar services and various aspects governing medical schemes are legislated in South Africa, each scheme nevertheless has its own set of rules, regulations, exclusions, penalties, and waiting periods, which may or may not apply – again depending on the applicant’s personal medically related circumstances.
Factors that May Affect Immediate Medical Aid Cover
As already mentioned, each new application for medical aid cover received by KeyHealth is subject to various checks, balances, and considerations that will determine whether cover as per the selected plan or option will apply with immediate effect, or whether there are any waiting periods or exclusions. For this and another important reason, it’s imperative that the applicant complete the application questionnaire in full, honestly and transparently. Failure to do so may result in the membership being declined altogether or the repudiation of relevant claims at a later date. Consider the following:
- Legally, KeyHealth is entitled to request a health certificate from any applicant and/or listed dependant.
- Our standard Proof of Health document consists of the completed and signed “Medical Details” section of our application form. Non-disclosure may result in claim rejection or further, even legal, action.
- If the applicant or dependant has a pre-existing medical condition, KeyHealth has the right to exclude this person from claiming benefits for this particular condition for an initial 12-month period.
- Should the applicant/dependant not have been a member of a medical aid scheme for 90 days or longer before applying to KeyHealth, a general waiting period of up to three months (for all conditions, including PMBs), and a condition-specific (pre-existing conditions) waiting period of up to 12 months may apply, which also includes PMBs.
- A waiting period of up to 12 months may apply to persons who have been a member of a scheme for 24 months continuously, terminated within less than 90 days prior to application at KeyHealth, but this excludes PMBs.
- The same exclusion may apply to applicants who have been subject to an unexpired general or condition-specific waiting period, for the remaining duration of that former medical aid exclusion period.
- Late joiner percentage penalties may be applied and added to monthly contributions, subject to specific conditions.
In order to avoid exclusion periods and conditions, loading of contributions, restrictions, or termination of membership, it’s essential to join a medical aid scheme early in life, and remain on one or another scheme continuously without a break, indefinitely. This will go a long way to ensure that your membership of a new scheme provides you with cover that starts immediately after your application is approved and your first contribution has been paid.
