Last reviewed: October 2026. We review our guides regularly to keep them accurate.
By Roxanne Hurter-Ehlers, Director of People and Governance at Curemed. Reviewed by Hagop Jaghlassian, CEO.
A South African medical scheme may impose only two kinds of waiting period: a general waiting period of up to three months and a condition-specific waiting period of up to 12 months. Which one applies, and whether prescribed minimum benefits (PMBs) are paid during that time, depends on how long you were covered before and whether there was a break of 90 days or more before your application. These limits sit in section 29A of the Medical Schemes Act 131 of 1998, and a scheme may not write anything stricter into its rules.
In short
- No cover in the 90 days before you apply: up to three months general plus up to 12 months condition-specific, and PMBs may be excluded during that time.
- Continuous cover of up to 24 months, ended less than 90 days before you apply: up to 12 months condition-specific only, with PMB treatment still paid.
- Continuous cover of more than 24 months, ended less than 90 days before you apply: up to three months general only, with PMB treatment still paid.
- Changing option inside the same scheme, registering your own child born during membership within the scheme time limit, or a transfer forced by a change of employer: no new waiting period.
- The 90 days run to the date of application, not the date new cover starts, so apply before your old cover ends.
What does the Medical Schemes Act mean by a waiting period?
Section 1 of the Act defines a general waiting period as a period in which a beneficiary is not entitled to claim any benefits. A condition-specific waiting period is a period during which a beneficiary may not claim for a condition for which medical advice, diagnosis, care or treatment was recommended or received within the twelve months ending on the date of application.
The detail lives in section 29A, inserted by section 10 of Act 55 of 2001, and section 29(3)(c) bars scheme rules from imposing waiting periods other than those section 29A provides. You can read the consolidated text in the Council for Medical Schemes (CMS) consolidated Act PDF.
How do the two types of waiting period work in practice?
During a general waiting period you pay contributions but may not claim at all, subject to the PMB carve-outs explained below. During a condition-specific waiting period you can claim normally, except for the specific conditions you received advice or treatment for in the 12 months before you applied.
Is a late joiner penalty the same thing?
No. Late joiner penalties sit in Regulation 13 (with definitions in Regulation 11), apply from age 35 and add a loading to contributions. Section 29A does not deal with them, so a person can face a waiting period, a penalty, both or neither.
Which section 29A waiting period applies to your situation?
The table below sets out the six situations the Act covers.
| Situation at date of application | General waiting period | Condition-specific waiting period | PMBs during the waiting period | Subsection |
|---|---|---|---|---|
| Never a member, or no cover for the 90 days before applying | Up to three months | Up to 12 months | May be excluded | 29A(1) |
| Continuous cover of up to 24 months, ended less than 90 days before applying | None (an unexpired period from the old scheme may be carried over) | Up to 12 months | PMB treatment and diagnostic procedures must be paid | 29A(2) |
| Continuous cover of more than 24 months, ended less than 90 days before applying | Up to three months | None | PMB treatment and diagnostic procedures must be paid | 29A(3) |
| Change of benefit option within the same scheme | None (a period already running on the current option may continue) | None (a period already running may continue) | Not affected | 29A(4) |
| Child-dependant born during the period of membership (see the note below on registration and grandchildren) | None, if registered within the scheme time limit | None, if registered within the scheme time limit | Not affected | 29A(5) |
| Transfer required by a change of employment, or an employer changing or ending its scheme | None (an unexpired period from the old scheme may be carried over under 29A(8)) | None (same carry-over rule) | Not affected | 29A(6) |
One point the Act does not settle cleanly is a membership of exactly 24 months. Subsection (2) says up to 24 months and subsection (3) more than 24 months, and schemes paraphrase the boundary differently, so confirm in writing which subsection the new scheme will apply.
The newborn exemption is also narrower than the table row suggests. The CMS guide on waiting periods says a scheme may apply waiting periods if the baby is not registered within the time frame set in its rules. A child added as a third generation dependant, for example a grandchild added to a grandparent membership, is a separate application for admission as a dependant, and the scheme could impose a waiting period. Check the scheme rules before relying on the exemption.
How are the 90 days counted when you switch schemes?
The 90 days run from the day your previous cover ended to the date of application, not to the day your new cover starts. That matters in switching season, when people often resign in November and only apply to the new scheme in the new year.
Take a member whose last covered day was 31 July 2026 and who applies on 30 October 2026. August contributes 31 days, September 30 and October 30, giving 91 days. That is 90 days or more, so section 29A(1) applies: the new scheme may impose both waiting periods and may exclude PMBs while they run.
Now take a member whose last covered day was 31 August 2026 and who applies on 27 October 2026. September contributes 30 days and October 27, giving 57 days. That is under 90, so the member keeps the protection of subsection (2) or (3), depending on how long they were covered.
The Act does not spell out how the end and application days are counted, so do not cut it close. Applying while your current cover is still active removes the question.
What do the rules mean for two households moving on 1 January 2027?
Thandi: six years of continuous cover
Thandi resigns from her scheme so that cover ends on 31 December 2026, and applies to a new scheme in early December for cover from 1 January 2027. There is no break, and she has been covered for more than 24 months, so section 29A(3) applies.
The new scheme may impose a general waiting period of up to three months, for example 1 January to 31 March 2027, but it must pay for PMB treatment and diagnostic procedures during that time. It may not impose a condition-specific waiting period on her at all.
Sipho: 18 months of continuous cover
Sipho has been a member for 18 months and switches with no break, so section 29A(2) applies. The new scheme may not impose a new general waiting period, but it may impose a condition-specific waiting period of up to 12 months, limited to conditions for which he received advice, diagnosis, care or treatment in the 12 months before applying. PMB treatment remains payable.
If his old scheme had a waiting period with four months still to run, the new scheme may apply those four months. Sipho should ask his old scheme for a membership certificate that shows his join date and any waiting periods on record.
Does changing benefit option inside your scheme restart a waiting period?
No. Section 29A(4) says no general or condition-specific waiting period may be imposed on a beneficiary who changes from one benefit option to another within the same scheme. The only exception is a waiting period already running on the current option, which may continue for its remaining term.
What differs is timing. Schemes allow option changes once a year, effective 1 January, and each sets its own cut-off for the paperwork. We explain the mid-year position in our guide to changing a medical aid plan during the year.
| Scheme | Verified position for a 1 January 2027 option change |
|---|---|
| Bonitas | Submit the 2027 change of option form on or before 30 November 2026 (31 October 2026 for Persal members). The change applies from 1 January 2027. |
| Bestmed | Rule 16.2 of the published 2026 rules: changes only from 1 January, with a written application by not later than 31 December before the year of change. Rule 12.2.1: resignation needs one month written notice. |
| Medshield | 2027 adjustments document (subject to CMS approval): option changes only with effect from 1 January, and mid-year changes are not permitted. No deadline is stated. |
| Discovery | 2026 underwriting policies: members may change plans at the end of each year, effective 1 January. We found no 2027 deadline in official documents at the time of writing. |
We could not verify a published 2027 deadline for Momentum, Fedhealth, Medihelp or KeyHealth when this article was written. Check the notice your scheme sends you. The CMS open season guidance for 2026 advised members to finalise decisions by late November or early December. Our list of medical aid schemes in South Africa is a useful starting point for comparing options.
When does a change of employer remove the waiting period?
Section 29A(6) says no waiting period may be imposed where the transfer is required because of a change of employment, or because an employer changes or terminates the scheme its employees belong to, provided prior cover ended less than 90 days before the application.
Section 29A(8) adds a catch: an unexpired waiting period from the former scheme may still be carried over. The CMS consumer booklet and Discovery describe this exemption as applying to moves from a closed or restricted scheme, wording the Act does not contain, so check how your new scheme reads it.
Can a scheme stretch a waiting period to related conditions?
The CMS says no. In CMScript 6 of 2024 the regulator describes a case where a scheme imposed a waiting period for hypertension and then extended it to stroke, heart attack and kidney failure. The CMS position is that it is incorrect to extend this waiting period to the related conditions.
A waiting period must attach to the disclosed condition, not to every condition a scheme fears might follow from it.
Where does an Advisor fit in before you resign?
The waiting period you face is decided by three facts: your continuous membership period, the gap between your old cover ending and your application date, and any unexpired waiting period on your current option. A Curemed Advisor can confirm those dates, read the new scheme rules against section 29A and time your resignation and application so that you do not create a break by accident. If you are still weighing options, our guide on how to choose medical aid in South Africa covers the other factors worth comparing.
Frequently asked questions
I am pregnant and joining a scheme for 2027. Does a waiting period apply to the birth?
Section 29A has no pregnancy-specific rule, so the same table applies. If you received antenatal advice or care in the 12 months before applying, a condition-specific waiting period may apply under subsection (1) or (2), and under subsection (1) PMBs may also be excluded. Ask the new scheme in writing how it will treat maternity claims before you resign.
Who pays for a medical report or test the new scheme asks for?
Under Regulation 12, a scheme that requires a medical report pays for the tests or examinations it requires. Section 29A(7) limits such reports to conditions for which advice, diagnosis, care or treatment was recommended or received in the 12 months before application.
Can I add my spouse mid-year without a waiting period?
A spouse added as a dependant is assessed under section 29A on their own history, not yours. If your spouse had no cover in the 90 days before the application, subsection (1) allows both waiting periods and PMBs may be excluded. If they move across from their own scheme with a break of less than 90 days, subsection (2) or (3) applies according to their membership length. The subsection (5) exemption covers a child born during the membership and registered in time, not an adult dependant.
What happens if I leave a condition off the application form?
Section 29(2)(e) lets a scheme cancel or suspend membership for non-disclosure of material information. CMScript 6 of 2024 lists denial of claims, termination of membership and legal consequences as possible outcomes, and questionnaires can ask about advice from a pharmacist, not only doctors. The Bonitas 2026 application form warns that the scheme may cancel membership retrospectively from inception or reverse claims already paid.
Does Gap Cover start on the same day as the new medical aid?
Not automatically. Gap Cover is short-term insurance, separate from a medical scheme, and it has its own waiting periods under different rules. Line up its start date with your new scheme membership. Our complete guide to Gap Cover in South Africa explains how the two products fit together.
Can a broker get my waiting period waived?
Section 29A sets maximums and uses the word may, so a scheme is allowed to apply a shorter period or none at all. An Advisor can present your cover history accurately and ask the scheme to apply less than the maximum, but no broker can promise a waiver. The decision rests with the scheme.
Roxanne Hurter-Ehlers
Director of People and Governance | Curemed Health and Wealth Consultants
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