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Frequently Asked Questions: Medical aid membership

How do I join a medical aid

You need to complete an application form to join a medical aid. Atfin Consulting however will do an analysis based on your specific requirements, and will provide you with costs as well as benefits on various schemes which may suit your requirements. Once you have chosen a scheme we will give you an application form to complete which will then be sent to the respective scheme for underwriting. Factors which will be taken into consideration when applying will be; total previous membership, pre-existing medical conditions, reason for wanting to change schemes etc. Our consultants will keep you informed on the progress of your application from start to finish.

Can I belong to more than one scheme at the same time

No, this is illegal. The Medical Scheme Act strictly prohibits this.

Will I receive a membership card

Yes, all medical schemes will issue new members with a membership card. This will contain all your basic details – name, surname, membership number, birth date, join and benefit date for you and your dependants. You must present this card to Service Providers as this will serve as proof that you belong to a medical aid.

Must I give notice to the medical scheme if I want to terminate my membership

Yes. Each scheme has their own time frame for resignations. Some schemes will require 3 months notice while others will terminate on 1 months notice. It is always useful to check with the scheme first prior to cancelling your membership

What does a waiting period mean?

A period during which a beneficiary has to pay his normal monthly contribution but is not entitled to claim any benefits from the scheme

What are the types of waiting periods schemes can give you?

  1.     General waiting period of up to 3 months
  2.     Condition-specific waiting period of up to 12 months (pre-existing medical conditions)

When is the medical scheme allowed to impose the 3 month general waiting period?

According to the Medical Schemes Act, a medical aid may impose a waiting period of up to 3 months in the following instances

  1.     Where an applicant has not been a member of a medical aid scheme for a period of at least 90 days preceding the date of application
  2.     Where an applicant was previously a beneficiary of a medical aid scheme for a continuous period of up to 24 months, terminating less than 90 days immediately prior to the date of application
  3.     Where the applicant has previous medical scheme coverage for 24 months or more but opts to join another scheme on a VOLUNTARY basis (selectivity)

What is a condition-specific waiting period?

This is a period during which a beneficiary is not entitled to claim benefits in respect of a condition for which medical advice, diagnosis, care or treatment was recommended or received within the 12 month period ending on the date on which an application for membership was made.

Are there instances where a waiting period will not apply

  • A child dependant born during the period of membership
  • A member who changes from one benefit option to another within the same medical scheme unless that member is subject to a waiting period on the current benefit option, in which case any remaining        period may be applied
  • Where the employer is changing or terminating the medical scheme of it’s employees, in which case such a transfer shall occur at the beginning of the financial year, or reasonable notice must be given to the medical scheme

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Registration No. 2004/021120/07 | An Authorised Financial Services Provider Licence No. 6896 | Council of Medical Schemes No. 2825