Discovery Health Late Joiner Fee
Overall, the Discovery Health Medical Scheme is a trustworthy and comprehensive medical aid provider. New Members 35 years or older may be subject to late-joiner penalties on Discovery Health Medical Aid Plans. The Discovery Health Medical Aid Plans start from R930 ZAR per month. Bestmed Medical Scheme has a trust rating of 4.8.
| 🔎 Medical Aid | 🥇 Discovery Health |
| 💵 Late Joiner Fee | ✅ Yes |
| 💚 Late Joiner Age | 35+ |
| 💶 Plan Cost (from) | R930 ZAR |
Discovery Health Late Joiner Fees – 9 Key Point Quick Overview
- ✅ Discovery Health Late Joiner Fees – What to know before Joining
- ✅ Discovery Health Waiting Periods
- ✅ Discovery Health Exclusions
- ✅ Discovery Health and Pre-existing Conditions
- ✅ Late Joiner Fees vs. Waiting Periods: What is the Difference?
- ✅ What Happens if You Do Not Pay Late Joiner Fees?
- ✅ National Health Insurance (NHI) Bill South Africa
- ✅ Our Verdict on Discovery Health Late Joiner Fees
- ✅ Discovery Health Late Joiner Fees Frequently Asked Questions
Discovery Health Late Joiner Fees – What to know before Joining
Discovery Health applies late-joiner penalties to applicants or dependents who meet the criteria of a late joiner. A late joiner is someone who is 35 years or older and was not a member of a registered South African medical scheme since 1 April 2001 or has had a break in coverage of more than three months since 1 April 2001.
Prospective members must note the following regarding Discovery Health’s late joiner fees:
- ✅ Late-joiner penalty concessions no longer apply for KeyCare members younger than 50 in the lowest income band.
- ✅ Members younger than 46 with no pre-existing conditions and a calculated late-joiner-penalty percentage of 5% or 25% will not have to pay the late-joiner penalty.
- ✅ Late-joiner penalties apply to individual members, Status D schemes, and group schemes.
- ✅ Expatriates returning to South Africa may not be charged late-joiner penalties if they meet specific criteria.
- ✅ Members can remain on the Scheme while working or traveling overseas for at least three months to a maximum of five years.
- ✅ Late-joiner penalties only apply to risk benefits, which are used to pay for hospital stays and chronic medicine, and not to Medical Savings Accounts (if applicable).
- ✅ The late-joiner penalty is calculated by adding a certain percentage to a member’s contribution for the risk benefits.
- ✅ The medical scheme or schemes that a member belonged to must be registered with the Council for Medical Schemes to exclude any period of cover as a dependent under the age of 21 from calculating the late-joiner penalty.
- ✅ Late-joiner penalties may also apply to new dependents added to existing Scheme memberships and to members and dependents moving between Discovery Health Medical Scheme memberships.
- ✅ Members can move to the lowest income band on a KeyCare plan if they are working in another country for an extended time (minimum three months to maximum five years) and can upgrade to any plan as soon as they return to South Africa, but only if they do so within three months of returning.
Late-joiner penalty concessions do not apply to members or dependents who join through a Status D employer group.
Discovery Health Waiting Periods
Discovery Health’s waiting periods are as follows:
- ☑️ Discovery Health applies waiting periods to all new members and members upgrading to a more inclusive plan and dependents added to existing memberships.
- ☑️ The waiting period’s duration depends on the benefit type and the member’s chosen plan.
- ☑️ For all plans except KeyCare, the general waiting period for hospital benefits is three months. In contrast, the waiting period for all other benefits is one month.
- ☑️ The typical hospital benefits waiting period for KeyCare plans is six months.
- ☑️ Certain chronic conditions and other specified medical conditions are subject to a 12-month condition-specific waiting period.
- ☑️ The general waiting period for the maternity and childbirth benefit is 12 months.
- ☑️ The general waiting period for the emergency medical transportation benefit is three months.
- ☑️ There is a standard 12-month waiting period for accident- or injury-related medical expenses.
- ☑️ If a member switches to a more comprehensive plan, any waiting periods already served under the previous plan will be considered.
- ☑️ Suppose a member or dependent has had continuous cover under a South African medical scheme without a break of more than 90 days. In that case, the waiting periods for new members will be shortened or waived entirely.
If a member or dependent has previously been covered by a foreign medical plan or travel insurance, the waiting period for a new membership will be reduced or waived entirely for the emergency medical transportation benefit only.
Discovery Health Exclusions
Discovery Health has some of the following Exclusions:
- ✅ Reconstructive surgical procedures and treatments, including cosmetic procedures and treatments.
- ✅ Otoplasty for bat ears, blepharoplasty, and port-wine stains (eyelid surgery).
- ✅ Breast reductions or augmentations and gynecomastia are considered cosmetic procedures.
- ✅ Obesity
- ✅ Unless included in Prescribed Minimum Benefits (PMBs) or Assisted Reproductive Therapy, infertility is not covered (ART) Benefit.
- ✅ Frail care
- ✅ Abuse of alcohol, drugs, or solvents.
- ✅ Willful and significant infraction of the law.
- ✅ Willful participation in a war, a terrorist act, a riot, a civil disturbance, a revolt, or an uprising.
- ✅ Injuries incurred or medical care rendered during travel to or within a country at war.
and more. A full list of exclusions will be made available by Discovery Health.
Discovery Health and Pre-existing Conditions
When joining a medical aid scheme, it is important to note that there is usually a waiting period of 12 months before any pre-existing conditions are covered. Therefore, joining a medical aid scheme earlier in life is advisable, rather than waiting until old age when the risk of developing chronic health conditions is higher.
Additionally, it is important to note that some medical aid schemes, such as Discovery Health, have specific policies regarding pre-existing conditions.
Therefore, it is important to research and understands the policies of a medical aid scheme before joining to ensure that you are fully aware of any waiting periods or limitations regarding pre-existing conditions.
Late Joiner Fees vs. Waiting Periods: What is the Difference?
Late Joiner Fees are a one-time penalty fee charged by medical aids if you join after a certain age or have never been a member of a medical aid program. Waiting periods, on the other hand, are periods during which you are not covered for certain medical aid benefits.
These waiting periods apply to all new members, regardless of whether they are charged Late Joiner Fees. Depending on the benefit, waiting periods can range from three to twelve months.
What Happens if You Do Not Pay Late Joiner Fees?
Your medical aid membership may be suspended or terminated if you fail to pay the Late Joiner Fees. The scheme may also pursue legal action to collect overdue fees. If your membership is suspended, you cannot access medical aid benefits until you have paid any outstanding fees.
If your membership is terminated, you must reapply for membership and may be subject to even higher Late Joiner Fees. Therefore, paying your Late Joiner Fees on time is crucial to prevent interruptions in your medical aid coverage.
National Health Insurance (NHI) Bill South Africa
In South Africa, the NHI is a proposed universal health coverage system. It is still in the planning stages, but it could affect Late Joiner Fees and other facets of medical aid.
Our Verdict on Discovery Health Late Joiner Fees
In conclusion, Discovery Health’s late joiner fees are applied to applicants or dependents who meet the definition of a late joiner, as defined by the Medical Schemes Act.
These penalties are calculated based on the years that a member or dependent has not been a member of a registered South African medical scheme since age 35, excluding any period of cover as a dependent under age 21. While late joiner penalties may seem like an additional expense, they ensure that individuals who choose to join medical schemes later in life contribute fairly to the scheme.
By carefully reviewing the criteria for late joiner penalty concessions and taking steps to ensure compliance, applicants can potentially avoid these penalties or reduce their impact.
Discovery Health Late Joiner Fees Frequently Asked Questions
Why does Discovery charge Late Joiner Penalties?
The Discovery late-joiner penalties are meant to encourage people who have not yet joined a South African health scheme to do so while they’re still young and healthy.
How does Discovery calculate Late Joiner Penalty Fees?
At Discovery the late-joiner penality is calculated using the age of the member and the creditable medical scheme coverage that the member had on the date of the application. Creditable medical cover (or coverage) refers to any period in which a person was a South Africa medical plan member or dependent.
Will Discovery waive Late Joiner Penalties?
Discovery Health may waive Late Joiner Fees for members who meet certain requirements, including being younger than 46 years old and having no pre-existing medical conditions. Under certain circumstances, the Late Joiner Fees may be waived for expatriates returning to South Africa within five years of departure.
What percentage is charged by Discovery as a Late Joiner Penalty?
Percentages charged depend on the number of years that you have been without a medical aid after age 35 and are as follows: 1-4 years: 5%, 5-14 years: 25%, 15-24 years: 50%, 25 years and more: 75 %.
