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Late-Joiner Penalties
How the penalty for joining after 35 is calculated, and how to reduce it.
By Roxanne Hurter-Ehlers, Director of People and Governance
Late-Joiner Penalties on Medical Aid in South Africa (2026)
A late-joiner penalty is a permanent amount added to your monthly medical scheme contribution if you join, or rejoin, at age 35 or older without enough prior cover. It is set under Regulation 13 of the Medical Schemes Act regulations. This guide explains who it applies to, how it is calculated, and how it can be reduced.
Who it applies to
The penalty can apply to a member or adult dependant who is 35 or older at the date of application and does not have enough creditable coverage. It excludes anyone who has had continuous medical scheme cover from a date before 1 April 2001 without a break of more than three months since then. A scheme may choose whether to apply the penalty, but it cannot charge more than the regulated maximum.
How it is calculated
The penalty band is found with the formula A = B minus (35 plus C), where B is your age at application and C is your years of creditable coverage. The value of A places you in one of four bands, each with a maximum loading on your contribution:
| Years without cover (A) | Maximum penalty |
|---|---|
| 1 to 4 years | 5% |
| 5 to 14 years | 25% |
| 15 to 24 years | 50% |
| 25 years or more | 75% |
These are maximums. A scheme may apply a lower penalty but never a higher one.
What counts as creditable coverage
Creditable coverage is the time you spent as a member or dependant of a registered medical scheme, and certain other cover such as some exempt entities and South African National Defence Force medical benefits. Any period you were a dependant under the age of 21 does not count.
It is permanent, but can be recalculated
The penalty is permanent and continues even if you move to another scheme. It can be reduced if you later provide evidence of additional creditable coverage, in which case the scheme recalculates it from the date you provide the evidence. A sworn affidavit can serve as proof where documents cannot be obtained.
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A registered broker conducts a needs analysis (required under the FAIS Act) covering your health needs, chronic conditions, family composition, hospital preferences and budget, then maps those needs to the right plan across the open schemes. Curemed is FSP 44098 and accredited by the Council for Medical Schemes as ORG 163. See our credentials.
Frequently asked questions
What is a late-joiner penalty?
A permanent percentage added to your monthly contribution if you join a medical scheme at age 35 or older without enough prior creditable cover.
How is the penalty calculated?
Using A equals your age minus 35 minus your years of creditable coverage. The result places you in a band with a maximum loading of 5%, 25%, 50% or 75% of your contribution.
What counts as creditable coverage?
Time as a member or dependant of a registered scheme, and certain exempt and defence-force cover, but not any period you were a dependant under age 21.
Is the penalty permanent?
Yes. It applies for as long as you are a member and continues even if you move to another scheme.
Can the penalty ever be reduced?
Yes. If you later prove additional creditable coverage, the scheme must recalculate and apply the lower penalty from the date you provide the evidence. A sworn affidavit can serve as proof.
I had medical aid for decades. Will I be penalised if I switch at 55?
Generally no. With enough creditable coverage the formula produces zero or a negative value, so no penalty applies. The penalty targets gaps in cover after 35, not the act of switching.
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Roxanne Hurter-Ehlers
Director of People and Governance | Admitted Attorney, Founder and MD of RH Attorneys, FAIS Key Individual
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