By Tegan Botha, Medaid Quote.
In short
- If you had no medical scheme cover for at least 90 days before you apply, a scheme may impose a general waiting period of up to three months and a condition specific waiting period of up to 12 months (Medical Schemes Act 131 of 1998, section 29A).
- If you are 35 or older and cannot show enough past cover, a scheme may add a late joiner penalty of up to 0.05, 0.25, 0.5 or 0.75 times the contribution for your portion of the premium, depending on how many years you were without cover (General Regulations, Regulation 13, as substituted on 4 November 2002).
- Both are maximums. A scheme may impose less, or nothing at all, so ask what it will actually apply to you before you sign.
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When you join a medical scheme, waiting periods limit what you can claim in the first months, and a late joiner penalty can load the contribution if you are 35 or older without enough past cover. Both have legal maximums and both depend mainly on your cover history. This guide sets out what the law allows, as read on 22 October 2026.
What is a waiting period, and how long can it be?
The Act defines two kinds. A general waiting period is a period in which a beneficiary is not entitled to claim any benefits. A condition specific waiting period applies only to a condition for which medical advice, diagnosis, care or treatment was recommended or received in the 12 months before the application for membership (Medical Schemes Act, section 1).
Section 29A caps them at three months and 12 months, and section 29(3)(c) bars scheme rules from imposing any other waiting periods.
Which waiting period can a scheme apply to you?
It depends on whether you had cover in the 90 days before you apply, and for how long. The table sets out the six situations in section 29A.
| Your situation when you apply | Most a scheme may impose | Section |
|---|---|---|
| No medical scheme cover for at least 90 days before you apply | General waiting period up to 3 months, and condition specific waiting period up to 12 months | 29A(1) |
| Previous cover for a continuous period of up to 24 months, ending less than 90 days before you apply | Condition specific waiting period up to 12 months, but not for Prescribed Minimum Benefits, plus the unexpired part of any waiting period your old scheme imposed | 29A(2) |
| Previous cover for a continuous period of more than 24 months, ending less than 90 days before you apply | General waiting period up to 3 months, but not for Prescribed Minimum Benefits | 29A(3) |
| Changing option within the same scheme | None, except the remainder of a waiting period you are already serving | 29A(4) |
| A child born while you are a member | None | 29A(5) |
| Moving scheme because you changed jobs, or because your employer changed or ended its scheme, with cover ending less than 90 days before you apply | None, except the remainder of a waiting period your old scheme imposed | 29A(6) and 29A(8) |
Note the Prescribed Minimum Benefits wording in the table. Subsections (2) and (3) expressly protect treatment and diagnostic procedures covered within the Prescribed Minimum Benefits. Subsection (1) has no such exception. Read together, this means that if you had no cover for 90 days or more before applying, a scheme may exclude Prescribed Minimum Benefits during your waiting period too. That is the situation in which a gap in cover costs the most.
A scheme may ask for a medical report only about a condition treated or advised on in the 12 months before you applied (section 29A(7)), and must pay for the tests or examinations it requires for that report (General Regulations, Regulation 12).
Who counts as a late joiner?
Regulation 11 defines a late joiner as an applicant, or the adult dependant of an applicant, who is 35 years of age or older on the date of application. It excludes anyone who had cover with one or more medical schemes from a date before 1 April 2001, without a break in cover of more than three consecutive months since 1 April 2001.
Being a late joiner does not automatically mean a penalty. Under Regulation 13(1) a scheme may apply one, and only to the portion of the contribution for the member or adult dependant who qualifies.
How is the penalty band worked out?
Regulation 13(3) uses a formula: A equals B minus (35 plus C). B is your age when you apply. C is the number of years of creditable coverage you can demonstrate. A is the number of years used to find your band in the table below.
| Years without creditable coverage after age 35 (A) | Maximum penalty | Same maximum as a percentage |
|---|---|---|
| 1 to 4 years | 0.05 x contribution | 5% |
| 5 to 14 years | 0.25 x contribution | 25% |
| 15 to 24 years | 0.5 x contribution | 50% |
| 25 years or more | 0.75 x contribution | 75% |
Two worked examples, both using a hypothetical R3,000 a month for the late joiner portion. This is not a scheme rate.
- Applicant aged 50 who has never had cover: A is 50 minus (35 plus 0), which is 15. That falls in the 15 to 24 year band, so the penalty may be up to 0.5 times R3,000, or R1,500 a month.
- Applicant aged 50 who can prove 12 years of creditable coverage: A is 50 minus (35 plus 12), which is 3. That falls in the 1 to 4 year band, so the penalty may be up to 0.05 times R3,000, or R150 a month.
Creditable coverage, defined in Regulation 11, is time as a member or dependant of a medical scheme, of a formerly exempt entity doing the business of a medical scheme, or of the Permanent Force Continuation Fund, and time with medical benefits from the South African National Defence Force as a uniformed employee or dependant. Cover as a dependant under 21 does not count.
Under Regulation 13(5), a penalty may continue to apply if you later move to another scheme.
Should you join now, or wait until you need cover?
There is a trade off either way, and the law is built to discourage joining only when you expect to claim.
- Joining earlier, or avoiding gaps, means paying contributions in years when you may claim little. In return you build creditable coverage, and if you move schemes with a gap of less than 90 days, the waiting periods a new scheme may impose are narrower and Prescribed Minimum Benefits stay protected.
- Waiting saves contributions now. The cost comes later: after a gap of 90 days or more, up to three months with no claims and up to 12 months without cover for recently treated conditions, and after 35 each uncovered year can move you into a higher penalty band.
- If you are between jobs or cutting costs, a lower priced option on the same scheme avoids new waiting periods (section 29A(4)), while dropping cover completely does not.
Which side weighs more depends on your age, health, budget and how long a gap would last. Our medical aid overview explains how option types differ in price and cover.
How to check this yourself
- Read section 29A and Regulations 11 and 13 in the consolidated Medical Schemes Act and Regulations published by the Council for Medical Schemes.
- Ask your previous scheme for a certificate of cover. Regulation 3(2) requires a scheme to issue one within 30 days of membership ending, or at any time a former member or dependant asks, showing the period of cover, the type of cover and whether you qualified for late joiner status.
- Count your years of cover after age 21, then apply the Regulation 13(3) formula to your age at the date of application.
- Before you sign, ask the scheme in writing which waiting periods and which penalty it will apply to each person on the application, and on what basis.
- If you believe a scheme applied a waiting period or penalty outside these rules, you can raise it with the scheme first and then with the Council for Medical Schemes.
For more plain language explainers, see our medical aid guides.
Frequently asked questions
Do years on a parent medical aid as a child count?
Only from age 21. Regulation 11 excludes cover as a dependant under 21 from creditable coverage.
What if I cannot find proof of my old cover?
A sworn affidavit is sufficient proof if it states the periods and the names of the schemes or entities, and that reasonable efforts to get documents were unsuccessful (Regulation 13(6)). If you produce evidence after a penalty has been imposed, the scheme must recalculate it, but the revised penalty applies only from the time you provide the evidence (Regulation 13(4)).
Does my newborn baby have to serve a waiting period?
No. A scheme may not impose a general or condition specific waiting period on a child dependant born during the period of membership (section 29A(5)).
Is a penalty the same at every scheme?
Not necessarily. Regulation 13 sets maximums that a scheme may apply, so the loading can differ. Compare the penalty each scheme quotes, not only the base contribution.
I had cover before April 2001. Can I still be a late joiner?
Not if your cover started before 1 April 2001 and has had no break of more than three consecutive months since then. A longer break means the exclusion no longer applies, and your creditable coverage is used to work out any penalty.
If you would like quotes compared across several medical schemes, you can request a free medical aid quote.
Last reviewed: 22 October 2026. Sources: Medical Schemes Act 131 of 1998, sections 1, 29(3)(c) and 29A, as amended to Act 11 of 2013; General Regulations, Regulations 3, 11, 12 and 13 (Regulations 11 to 13 as substituted by GN R1360 of 4 November 2002); CMS consolidated text, read 22 October 2026. No later amendment to section 29A or Regulations 11 and 13 was found.