Last reviewed: September 2026. We review our guides regularly to keep them accurate.
By Hagop Jaghlassian, CEO at Curemed. Reviewed by Roxanne Hurter-Ehlers, Director of People and Governance.
A late joiner penalty is an extra percentage that a South African medical scheme may add to the contribution of an applicant or adult dependant who joins at age 35 or older without enough previous medical scheme cover. It comes from Regulation 13 of the Regulations to the Medical Schemes Act 131 of 1998 and is capped at four bands of 5%, 25%, 50% and 75% of the contribution portion for that person, based on the years after age 35 spent without creditable coverage. The ceiling is 75%, a scheme may charge less, and the penalty attaches to adults rather than children.
In short
Applies to applicants and adult dependants aged 35 or older at application, less any years of creditable coverage they can prove.
Four bands with maximums of 5%, 25%, 50% and 75%, charged only on the contribution portion for that person.
Proof of earlier scheme cover lowers or removes it. A certificate from your old scheme or a sworn affidavit is accepted.
Separate from waiting periods, which sit in section 29A of the Medical Schemes Act.
What is a late joiner penalty and who counts as a late joiner?
Regulation 11 defines a late joiner as an applicant or adult dependant who, at the date of application for membership or admission as a dependant, is 35 years of age or older. It excludes any beneficiary who enjoyed coverage with one or more medical schemes from a date before 1 April 2001, without a break in coverage exceeding three consecutive months since that date. Continuous cover since before April 2001, with no break over three months, means you are not a late joiner, whatever your age.
The rules sit in Chapter 4 of the Regulations (Regulation 11 for definitions, Regulation 13 for the penalty), not in section 29A of the Act, which covers waiting periods. Read the consolidated Regulations and the Medical Schemes Act. The Act link is the 2004 consolidation, so confirm the current text before relying on it.
Who pays the penalty and who does not?
The penalty attaches to the adult member or adult dependant who qualifies as a late joiner, and only to the portion of the contribution for that person. The penalty is not charged on the contribution portion for children. Regulation 13 says a scheme may apply a penalty: a permission, not an obligation, and rates differ between schemes.
How is the late joiner penalty calculated?
Regulation 13 sets out four bands. Each is a ceiling: a scheme shall not exceed the percentage shown but may charge less.
| Years without creditable coverage after age 35 | Maximum penalty on the contribution portion |
|---|---|
| 1 to 4 years | 5% |
| 5 to 14 years | 25% |
| 15 to 24 years | 50% |
| 25 or more years | 75% |
What is the formula behind the band?
The band comes from a short formula: A = B minus (35 + C). B is your age at application, C is the years of creditable coverage you can demonstrate, and A is your penalty years. Aged 45 with no previous cover gives 45 minus (35 + 0) = 10 penalty years, the 5 to 14 year band, so the maximum penalty is 25%.
What does a late joiner penalty look like for a family?
The figures below are hypothetical and do not reflect any real scheme price. A principal member aged 42 with no prior cover has a contribution portion of R3,000 a month. The formula gives 42 minus 35 = 7 penalty years, the 5 to 14 year band. The maximum penalty is 25% of R3,000, or R750, so the portion becomes R3,750.
The adult spouse is 40 with no prior cover and a portion of R2,500. That is 40 minus 35 = 5 penalty years, also the 5 to 14 year band. The maximum is 25% of R2,500, or R625, so the portion becomes R3,125.
Two children on the membership carry no penalty. At the ceiling the household pays R750 plus R625, a total of R1,375 a month or R16,500 a year, above the base contribution covered in our guide on how much medical aid costs in South Africa.
What changes when prior cover is proven?
If the principal member proves 3 years of creditable coverage, the formula becomes 42 minus (35 + 3) = 4 penalty years. That drops into the 1 to 4 year band with a maximum of 5%, so the penalty on R3,000 falls from R750 to R150 a month.
Why does one year of age matter at the boundary?
The bands step up sharply. Aged 39 with no cover is 4 penalty years and the 5% band; aged 40 is 5 penalty years and the 25% band. The regulation does not say how part years are rounded, so near a band edge ask the scheme in writing how it counts months.
What counts as creditable coverage and how do you prove it?
Regulation 11 defines creditable coverage as any period as a member or dependant of a medical scheme; of an entity doing the business of a medical scheme that was exempt from the Act at the time; as a uniformed employee of the South African National Defence Force or a dependant who received SANDF medical benefits; or as a member or dependant of the Permanent Force Continuation Fund. It excludes any period of cover as a dependant under the age of 21.
A hospital plan from a registered medical scheme is scheme membership, so in our reading of Regulation 11 it counts. Gap Cover is short term insurance, not a medical scheme, so in our reading it is not creditable coverage and does not remove a penalty. It carries its own waiting periods: see our complete guide to Gap Cover in South Africa.
What certificate must your old scheme give you?
Under Regulation 3(2), a scheme must, within 30 days of termination of membership or at any time on request, give the former member a certificate stating the period of cover, the type of cover and whether the person qualified as a late joiner. Under Regulation 3(3), a copy must be forwarded on request to a scheme the person later joins.
If you produce evidence after a penalty has been imposed, the scheme must recalculate and apply the revised penalty from the time the evidence is provided. It is not backdated.
How does a late joiner penalty differ from a waiting period?
A late joiner penalty raises your contribution. A waiting period limits what the scheme pays for in the early months, and it comes from section 29A of the Act rather than the Regulations.
Where a person was not a beneficiary of a medical scheme for at least 90 days before applying, a scheme may impose a general waiting period of up to three months and a condition-specific waiting period of up to 12 months, and prescribed minimum benefits may be subject to those waiting periods. Where cover ended less than 90 days before the application, section 29A(2) and (3) limit the waiting periods and carve out prescribed minimum benefits.
Keep the two time rules apart: the 90 day test decides waiting periods. The three consecutive months test belongs to the late joiner definition and only matters for people covered since before 1 April 2001. Our article on changing your medical aid plan mid year covers related switching questions.
How can you reduce or check a late joiner penalty?
The formula gives three levers. Age: joining, or adding an adult dependant, before 35 avoids the penalty. Creditable coverage: every year you prove reduces A by one, and a few years can drop you a band. Scheme choice: the bands are ceilings and schemes set their own rates, so ask each scheme for its rate in writing when you compare.
Ask about duration. The regulation is silent on how long the penalty lasts. In practice schemes charge it for as long as you remain a member; Bankmed, for one, states the penalty remains in effect for the entire membership duration. Discovery states its penalty applies to risk benefits and not the medical savings account portion, a scheme practice rather than law. Our guide on how to choose a medical aid in South Africa covers other questions to put to a scheme.
For a second pair of eyes, a Curemed Advisor can work through the formula with you, help gather proof of past cover and compare how schemes apply the penalty.
Frequently asked questions
What if I cannot get documents from a previous scheme?
Regulation 13(6) accepts a sworn affidavit as sufficient proof. It must set out the periods of cover and the scheme names, and state that reasonable efforts were made to obtain the documents. Ask the old scheme for a certificate first.
Does the penalty follow me if I switch to another scheme?
It can. The regulation states that penalties may continue to apply when the member or adult dependant moves to another scheme. Your certificate of cover records whether you qualified as a late joiner, and the new scheme applies its own rate within the bands.
Does Gap Cover or a hospital cash plan count as creditable coverage?
In our reading of Regulation 11, no. Creditable coverage is built around membership of a medical scheme or the specific bodies listed in the regulation. Gap Cover and hospital cash plans are insurance products, not scheme membership, so time on them does not reduce your penalty years. A hospital plan from a registered scheme does count.
What happens if I cancel my medical aid and rejoin later?
If you are 35 or older when you rejoin, you are a late joiner unless you hold the exemption for continuous cover since before 1 April 2001, and a break longer than three consecutive months ends that exemption. In our reading of the definition and formula, cover held before the break still counts as creditable coverage, so keep the certificate from the scheme you left.
Is it still worth joining a medical aid at 45 if I will pay a penalty?
That depends on your health needs, budget and alternatives, and it is a decision to make with full figures in front of you. At 45 with no prior cover the maximum penalty is 25% of your contribution portion, and every year you wait adds to the count until you reach the 50% band at 15 penalty years. A Curemed Advisor can compare how several schemes would apply the penalty to your situation.
