Medical aid question

[blue-eye-boy]

Well as some know, I was trying to start my own business, but that just wont work out. But now I can maybe get a decent job in Pietersburg, will know this week for sure.

But as soon as I can do it, I want to get a hospital plan. Just for one thing, me and my wife want a second baby. If I take out a medical or hospital plan, will the pregnancy be covered from day 1, if she is not pregnant on the day we take out the medical plan?

 

[LancelotSA]

There is usually a 12 month waiting period for pregnancies. This means all pregnancy related expenses will not be covered in the first 12 months after you join a medical aid.

If you are really, really lucky you may stumble across a special offer that waives waiting periods and late joiner penalties but unlikely.

 

[Hosehead]

I think you have to stay capped for the next 12 months.

 

[CellBel]

I think you have to stay capped for the next 12 months.

 

[blue-eye-boy]

And this waiting period is just for pregnancy?

 

[LancelotSA]

And this waiting period is just for pregnancy?

No, the 12 month waiting period is usually for any pre-existing conditions (ie conditions that you had prior to joining the medical aid). There is usually also a three month general waiting period if you have not been on another medical aid for a certain period of time prior to joining the new one. That means you have no cover for three months.

 

[Hosehead]

That means you have no cover for three months.

Bing Bing. Wrong. You still get prescribed minimum benefits during the 3 months. So if a bus hits you, you're covered.

 

[LancelotSA]

Bing Bing. Wrong. You still get prescribed minimum benefits during the 3 months. So if a bus hits you, you're covered.

Well if you would like me to quote the entire medical aid council's conditions then I will but this bore no relevance to the OPs question.

 

[Sting]

From my medical aid:

8.4 Waiting periods

8.4.1 The Scheme may impose upon a person in respect of whom an application is made for membership or admission as a dependant, and who was not a beneficiary of a medical scheme for a period of at least 90 days preceding the date of application-

8.4.1.1 a general waiting period of up to three months; and

8.4.1.2 a condition specific waiting period of up to 12 months.

8.4.2 The Scheme may impose upon a person in respect of whom an application is made for membership or admission as a dependant, and who was previously a beneficiary of a medical scheme for a continuous period of up to 24 months, terminating less than 90 days immediately prior to the date of application-preceding the date of application-

8.4.2.1 a condition-specific waiting period of up to 12 months, except in respect of any treatment or diagnostic procedures covered within the prescribed minimum benefits;

8.4.2.2 in respect of any person contemplated in this sub-rule, where the previous medical scheme had imposed a general or condition-specific waiting period, and such waiting period had not expired at the time of termination, a general or condition-specific waiting period for the unexpired duration of such waiting period imposed by the formed medical scheme.

8.4.3 The scheme may impose upon any person in respect of whom an application is made for membership or admission as a dependant, and who was previously a beneficiary of a medical scheme for a continuous period of more than 24 months, terminating less than 90 days immediately prior to the date of application, a general waiting period of up to three months, except in respect of any treatment or diagnostic procedures covered within the prescribed minimum benefits.

8.4.4 A general waiting period of 3 months, applies to a member and his dependants. Provided that the general waiting period shall not be imposed on a member or a dependant of a member who has been a member or a dependant of the member of one or more medical schemes for a continuous period of 2 years or more and applies for membership of the Scheme within a period of 3 months after termination of such previous membership. No waiting period shall apply in respect of the prescribed minimum benefits.

8.5 No waiting periods may be imposed on:

8.5.1 a person in respect of whom application is made for membership or admission as a dependant, and who was previously a beneficiary of a medical scheme, terminating less than 90 days immediately prior to the date of application, where the transfer of membership is required as a result of-

8.5.1.1 change of employment; or

8.5.1.2 an employer changing or terminating the medical scheme of its employees, in which case such transfer shall occur at the beginning of the financial year, or reasonable notice must have been furnished to the Scheme to which an application is made for such transfer to occur at the beginning of the financial year.

Where the former medical scheme had imposed a general or condition-specific waiting period in respect of persons referred to this rule, and such waiting period had not expired at the time of termination of membership, the Scheme may impose such waiting period for the unexpired duration of a waiting period imposed by the former medical scheme.

8.5.2 a beneficiary who changes from one benefit option to another within the scheme unless that beneficiary is subject to a waiting period on the current benefit option in which case the remaining period may be applied;

8.5.3 a child dependant born during the period of membership;