Medical Aid Waiting Periods

Medical Aid Waiting Periods in South Africa (2026)

A waiting period is a set time during which a new medical scheme member pays contributions but cannot yet claim certain benefits. South African schemes may apply waiting periods under Section 29A of the Medical Schemes Act. This guide explains the two types, the 90-day rule when you change schemes, and how Prescribed Minimum Benefits are protected.

The two types of waiting period

• General waiting period, up to 3 months. You pay contributions but cannot claim any benefits during this time.
• Condition-specific waiting period, up to 12 months. You are covered for everything except a named pre-existing condition, for which costs are out of pocket for up to 12 months.

When a scheme can apply them, and the 90-day rule

What a scheme may impose depends on your prior cover and the gap before you apply:

• New member, or a gap of 90 days or more since you last had cover: the scheme may apply both a 3-month general and a 12-month condition-specific waiting period.
• Continuous prior cover of up to 24 months, applying within 90 days of leaving: only a 12-month condition-specific waiting period may apply, and not for PMBs.
• Continuous prior cover of more than 24 months, applying within 90 days of leaving: only a 3-month general waiting period may apply, and not for PMBs.

Keeping the gap between schemes under 90 days is what preserves these protections.

When waiting periods do not apply

• Changing options within the same scheme (any unfinished waiting period simply continues).
• A child dependant born while you are a member.
• A transfer forced by a change of employment, or by your employer changing or ending the group scheme.

A scheme may also only impose a condition-specific waiting period for a condition you received advice, diagnosis or treatment for in the 12 months before applying.

Waiting period versus late-joiner penalty

These are different. A waiting period is a temporary delay in cover of up to 3 or 12 months and can apply at any age. A late-joiner penalty is a permanent percentage added to your contribution for joining at 35 or older without enough prior cover. You can face both at once.

Related guides

• Prescribed Minimum Benefits
• Late-joiner penalties
• Medical aid network plans
• Compare medical aid schemes

How a broker helps

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