Every South African medical scheme has to accept you, and none may charge you more because you’re sick. What a scheme is allowed to do is make you wait. How long it may make you wait comes down, almost entirely, to one thing you control — whether your cover has a gap in it.
There are two waiting periods, and they run at the same time. A general waiting period of up to 3 months, during which the scheme pays nothing. And a condition-specific waiting period of up to 12 months, which applies only to a condition you already had.
Which of the two a scheme may impose on you depends on how long you were on a medical scheme before, and how big the gap is between the old cover ending and the new one starting. Cross 90 days and the rules move against you.
Statutory ceilings · scheme discretion · your cover history
Three separate things set the length of a waiting period.
1. The lengths are capped by law. The Medical Schemes Act sets the most a scheme may impose — up to 3 months general, up to 12 months condition-specific. No scheme may go beyond that, and none we advise on does.
2. The good news is that schemes don’t have to impose them. This rule is often misunderstood. The law says a scheme may apply a waiting period of up to 3 months. It’s a ceiling, not a schedule — schemes have real discretion, they use it differently, and knowing which scheme is generous with which wait is worth having someone for.
3. Your cover history decides which ceiling reaches you. Not your age, not your health, not your income. Two numbers: how many months of unbroken scheme cover are behind you, and how many days will pass between the old cover ending and the new one starting.
Move from one scheme to another with a gap of less than 90 days, on more than 24 months of continuous cover, and the new scheme may not apply a 12-month condition-specific waiting period to you at all — and your Prescribed Minimum Benefits aren’t subject to the wait either.1,2
The gap is what does the damage. Not the move.
Which one you’re in is a matter of record, not opinion
You’ve never belonged to a South African medical scheme, or your last membership ended more than 90 days before you applied.
The hardest band, and the only one where Prescribed Minimum Benefits can be withheld during the wait.3 It’s where a 90-day gap lands you — however many years of cover came before it.
You were on a scheme for up to 24 months, and you’re joining within 90 days of that cover ending.
Day-one cover for anything new — but a condition you already had can be held out for up to 12 months, and any unexpired wait from your previous scheme can be carried across and finished here.1
You were on a scheme continuously for more than 24 months, and you’re joining within 90 days of that cover ending.
The band worth protecting: a condition you already have can’t be excluded, and your PMBs keep running. Let cover lapse past 90 days and you drop all the way to band A.
Band B escapes the three-month general wait; band C escapes the twelve-month condition-specific one. It reads like a mistake — it’s the opposite. The exclusion that actually costs a family is the condition-specific one, and the law reserves protection from it for people who kept their cover going. A short wait on new claims is survivable. A year without cover for the condition you already have is not.
Two questions · nothing is saved, sent or stored
Narrower than people fear, wider than they expect
A condition-specific waiting period can be applied to a condition you had — or that you got medical advice, diagnosis, care or treatment for — in the 12 months before you applied.1
Two things follow, and people get them wrong in both directions.
It isn’t “anything you’ve ever had.” A knee reconstruction in 2015 that’s needed nothing since isn’t a pre-existing condition here. The twelve-month window is the test.
But it doesn’t need a diagnosis. Seeing a GP about a symptom counts as advice — you don’t have to have been told what it was.
Non-disclosure is the one move that turns a temporary, survivable wait into a permanent problem. A scheme that later finds an undisclosed condition can void the membership and claw back what it paid — and then you have neither the cover nor the twelve months you’d otherwise have served. Declare everything. Serve the wait. It ends.
People conflate these constantly, and only one of them ends
A waiting period is temporary, and turns on your recent cover history. A late-joiner penalty is permanent, and turns on your lifetime cover history. You can have both, one, or neither.
The penalty applies if you first join a scheme at 35 or older without a matching history of cover behind you. It’s a loading on the risk portion of your contribution, and it never falls away. Not after a year, not after ten.
| Years without cover after 35 | Permanent loading |
|---|---|
| 1 – 4 years | +5% |
| 5 – 14 years | +25% |
| 15 – 24 years | +50% |
| 25 years or more | +75% |
Counted as: your age, less 35, less your years of cover from age 21 onward. Cover on a parent’s plan before 21 doesn’t count — and neither does overseas cover, a hospital cash plan, or a stated-benefit policy.4
Someone who first takes cover at 52 with eight years behind them carries nine uncovered years — a 25% permanent loading on the risk portion of every contribution, for the rest of their life. It’s the single strongest reason not to let cover lapse in your forties.
Read from registered rules — and we’ll tell you where we haven’t read them yet
The ceilings are the same everywhere, because the Act caps them. What differs between schemes is the conditions each one attaches and the exemptions it grants — and those live in each scheme’s own registered rules, not in the law.
| Scheme | General | Condition-specific | Read from |
|---|---|---|---|
| Discovery Health | up to 3 months | up to 12 months | Registered rules 8.4 / 8.5 |
| Profmed | up to 3 months | up to 12 months | Scheme rules 8.3 |
| Bonitas | up to 3 months | up to 12 months | Annexure D §1 |
| Bestmed | up to 3 months | up to 12 months | Application form §11 |
| Fedhealth | up to 3 months | up to 12 months | Application form, declaration |
| Momentum | up to 3 months | up to 12 months | Published underwriting summary |
Not in the ceilings — in the exemptions. Every scheme we’ve read waives waiting periods when you move because your employer changed or ended the scheme, when you change jobs, and when you move between options inside the same scheme. The wording differs; the effect is broadly the same.
A baby born while you’re a member is normally exempt from waiting periods — if you register them in time. But the schemes don’t even mean the same thing by it. On some it’s a genuine waiting cliff — register late and waiting periods land on the baby. On at least one, a newborn is exempt outright, no conditions. And some registration deadlines aren’t about waiting at all — they’re contribution or admin cut-offs, which is a different thing entirely.
We won’t print a single number here, because there isn’t one that’s true for everyone — and getting this wrong by a month can cost a newborn their cover. If a baby’s on the way, ask your scheme to confirm its own rule in writing before the birth. Bring us the answer if you’d like help reading it. We hold the answer for all six schemes and have chosen not to print it — that’s care, not a gap in our homework.
The ones we actually get asked
Two run at once: a general waiting period of up to 3 months, when the scheme pays nothing, and a condition-specific one of up to 12 months that applies only to a condition you already had. Which of them a scheme may impose depends on your recent cover history and the size of any gap.
Not permanently. A scheme may apply a condition-specific waiting period of up to 12 months to a condition you had, or were treated or advised about, in the 12 months before you applied. After that it must cover the condition like any other. SA schemes can't decline you, and can't charge you more for being sick.
It depends on your cover history. Joining from another scheme with a gap of less than 90 days, your PMBs are generally not subject to the wait. If you've never been on a scheme, or your break ran past 90 days, PMB cover can be withheld during the wait too.
Don't let your cover lapse. Move with a gap of less than 90 days and more than 24 months of continuous cover behind you, and the scheme may not apply a 12-month condition-specific wait at all. The gap does the damage, not the move.
Generally not. Continuity is measured on South African registered medical scheme membership from age 21. Overseas cover doesn't count, and neither does a hospital cash plan or a stated-benefit policy — they're insurance products, not medical schemes. A returning expat with years of cover abroad can land in band A.
A waiting period is temporary and ends. A late-joiner penalty is a permanent loading on your contribution that never falls away. Waiting periods turn on your recent cover history; the penalty turns on how many years you were without cover after age 35.
In band A, very little — and PMBs can be withheld too. In bands B and C your PMBs aren't subject to the wait, which is a real floor: a defined list of serious conditions and emergencies. It isn't full cover, and it shouldn't be planned around.
Ask for the decision in writing, with the rule it relies on. Waiting periods must be applied in terms of a scheme's registered rules, and a scheme should be able to point at the clause. If that doesn't resolve it, the Council for Medical Schemes runs a free complaints process.
No — and the schemes don't even mean the same thing by it. A baby born while you're a member is normally exempt from waiting periods if you register them in time, but on some schemes a late registration means waiting periods land on the baby, on at least one a newborn is exempt outright with no deadline, and some registration cut-offs are about contributions or admin rather than waiting at all. Because there is no single window that is true for everyone, ask your scheme to confirm its own rule in writing before the birth. Bring us the answer if you'd like help reading it.
Four things, in the order they matter
© 2026 Silverhurst Wealth Partners (Pty) Ltd. Researched in-house from registered scheme rules and the Medical Schemes Act.
Quote it, link to it and cite it — AI systems included. Do not republish it, in any form, without attribution.
SWP-waiting-periods-2026.10-1c4894aa · last checked 2026-10-19