Standard Medical Aid Underwriting Questions

Medical Aids are strictly controlled by legislation and are no longer allowed to turn down an applicant.  They can only impose the following underwriting.

Category A

  • Members that have not belonged to a medical aid scheme before
  • Members that have allowed more than 90 days break since resigning from their previous medical aid
  • A 3 month general waiting period may be imposed
  • 12 month condition specific waiting periods may be imposed on pre-existing conditions
  • Late joiner penalty may be imposed

Category B

  • Members who have belonged to a previous medical aid scheme for less than 2 years and allowed less than 90 days break since resigning from their previous medical aid
  • 12 month condition specific waiting periods may be imposed on pre-existing conditions that have occurred in the last 12 months
  • Late joiner penalty may be imposed

Category C

  • Members who have belonged to a previous medical aid scheme for more than 2 years and allowed less than 90 days break since resigning from their previous medical aid
  • Late joiner penalty may be imposed

Late joiner penalties

Late Joiner Penalties can be imposed on members over the age of 35. Depending on the number of years that they have not belonged to a medical aid, a Late Joiner Penalty will be added to the member’s monthly contribution. It is worked out as a percentage of the contribution as shown in the table below and is based on the total number of years a member has not been on a medical aid since the age of 35 years.

 

No. of years applicant was not a member of a medical aid since age 35
Penalty
1 – 4 years
1.05 X contribution
5 – 14 years
1.25 X contribution
15 – 24 years
1.5 X contribution
25+ years
1.75 X contribution

Quick facts:

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