Overview
This guide is designed to help members navigate and understand the waiting periods that are part of their health coverage plans. At Discovery Health, waiting periods are implemented to maintain fairness and sustainability within the scheme.
These periods are essential as they prevent the potential for abuse—such as individuals joining a medical scheme only when in need of significant medical treatment and then leaving once health is regained.
In this guide, we’ll explore the different types of waiting periods, what they mean for you as a member, and how they ultimately contribute to the efficacy and stability of your health coverage. Whether you are a new member or need a refresher, this guide will provide you with the necessary insights to understand how waiting periods work within Discovery Health Medical Scheme.
Waiting Periods of Discovery Health Members
- ✅ When a new member joins the Discovery Health medical aid scheme, they may encounter different waiting periods before they can claim certain benefits.
- ✅ Typically, there is a general waiting period of 3 months, during which no benefits can be claimed. Additionally, a condition-specific waiting period of up to 12 months may be applied.
- ✅ The exact waiting periods can vary based on whether the new member has had previous medical aid coverage and the duration since the end of their previous membership.
- ✅ For those who have been without a medical scheme or have had a break of more than 90 days, both a 3-month general and a 12-month condition-specific waiting period can be applied.
- ✅ However, certain prescribed minimum benefits may still be accessible during these waiting periods under specific conditions.
Individuals who have applied to join Discovery Health Medical Scheme, but have not belonged to a registered South African medical scheme before
- ✅ A three-month general waiting period and a 12-month condition-specific waiting period, if applicable.
- ✅ The individual will not have cover under the Prescribed Minimum Benefits.
- ✅ Late-joiner penalties may also apply
Individuals who have belonged to a registered South African medical scheme for a period of less than two years
- ✅ A 12-month condition-specific waiting period.
- ✅ If the previous medical scheme placed a general or condition-specific waiting period on a membership and the waiting period did not expire at the date of ending their membership with the previous medical scheme, we may apply the rest of the waiting period.
- ✅ The individual will have cover under the Prescribed Minimum Benefits.
- ✅ Late-joiner penalties may also apply
12-month condition specific waiting period
This will apply to the following conditions:
- ✅ You have a pre-existing condition
- ✅ You have never belonged to a medical scheme before
- ✅ You have had a break in medical scheme membership of more than 90 days
Conclusion
Understanding the waiting periods associated with applying for a medical aid plan from Discovery Health is crucial for managing expectations and making informed decisions about your healthcare coverage. By familiarizing yourself with the waiting periods for various services and conditions, you can navigate the enrolment process more effectively and ensure timely access to the care you need.
Remember to always review the specific terms and conditions of your chosen plan to fully grasp the waiting period implications and enjoy the benefits of comprehensive healthcare coverage.
