Makoti Late Joiner Fee

  Overall, Makoti is a trustworthy and comprehensive medical aid provider. New Members 35 years or older may be subject to late-joiner penalties on Makoti Medical Aid Plans. The Makoti Medical Aid Plans start from R406 ZAR per month. Makoti has a trust rating of 2.7.    

Makoti Late Joiner Fees - 9 Key Point Quick Overview

1. ✅ Makoti Late Joiner Fees – What to know before Joining
2. ✅ Makoti Waiting Periods
3. ✅ Makoti Exclusions
4. ✅ Makoti and Pre-existing Conditions
5. ✅ Late Joiner Fees vs. Waiting Periods – What is the Difference
6. ✅ What Happens if You Do Not Pay Late Joiner Fees?
7. ✅ National Health Insurance (NHI) Bill South Africa
8. ✅ Our Verdict on Makoti Late Joiner Fees
9. ✅ Makoti Late Joiner Fees Frequently Asked Questions

Makoti Late Joiner Fees - What to know before Joining

  Makoti Medical Aid scheme strictly adheres to legislation and cannot refuse applicants’ applications. However, they can impose underwriting rules such as a Late Joiner Penalty for members over 35.  The penalty amount is determined by the number of years that the member has not belonged to a medical aid since turning 35 and is added to the monthly contribution. The Late Joiner Penalty is calculated as a percentage of the monthly contribution, as indicated in the table below.   Late joiner fees may apply to the following scenarios:  

• ✅ Members who have never belonged to a medical aid scheme before.
• ✅ Members who have had a break in cover exceeding 90 days since resigning from their previous medical aid.
• ✅ A 3-month general waiting period may be enforced.
• ✅ 12-month condition-specific waiting periods may be imposed on pre-existing conditions, and a late Joiner Penalty could apply.

  Additionally, Late Joiner Penalties may be imposed on members who have belonged to a previous medical aid scheme for less than two years and allowed less than a 90-day break since resigning from their previous medical aid.  For pre-existing conditions that have occurred within the last 12 months, a 12-month condition-specific waiting period may be imposed. Furthermore, Late Joiner Penalties may be imposed on members who have belonged to a previous medical aid scheme for more than two years and allowed less than a 90-day break since resigning from their previous medical aid.  

Makoti Waiting Periods

  Makoti Medical Scheme may apply waiting periods to individuals applying for membership or as a dependent and who were not part of a medical scheme for at least 90 days before the date of application. This includes a general waiting period of up to three months and a condition-specific waiting period of up to 12 months.  

Makoti Exclusions

  Makoti Medical Scheme will not cover the following costs unless it forms part of the Prescribed Minimum Benefits (PMBs):  

• ✅ The treatment of obesity and its direct complications
• ✅ Items or treatments that are not medically indicated
• ✅ Willfully self-inflicted injuries
• ✅ Injuries arising from professional sports and speed contests
• ✅ The hire of medical, surgical, and other appliances
• ✅ The cost of surgical stockings
• ✅ Medical services provided by any person not registered with the Health Professions Council of South Africa, the South African Nursing Council, or the South African Pharmacy Council
• ✅ Recuperative holidays
• ✅ Dental extractions for non-medical purposes
• ✅ Gold inlays
• ✅ Unproven or experimental treatment
• ✅ Cosmetic and reconstructive surgery, treatment, or appliances
• ✅ Frail care and convalescence
• ✅ Employee medical examinations initiated by an employer
• ✅ Injuries where another party is responsible for the costs (e.g., Road Accident Fund or Workmen’s Compensation claims)
• ✅ Roaccutane and Retin A for the treatment of skin conditions
• ✅ Contraceptives and contraceptive devices

    and many more. A full list of exclusions will be made available by Makoti.  

Makoti and Pre-existing Conditions

  When joining a medical aid scheme, it is essential 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 Makoti, 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 aid 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 Makoti Late Joiner Fees

  Overall, the Makoti Medical Aid scheme ranks well as a medical aid scheme, with various benefits available to members, including hospital cover, chronic medication benefits, and wellness programs.  Makoti Medical Aid scheme imposes Late Joiner Fees to safeguard the scheme from selective abuse and offset potential costs. These fees apply to members who join the scheme after 35, have never belonged to a medical aid scheme before, or have had a break in cover exceeding 90 days since resigning from their previous medical aid. While Late Joiner Fees may negatively impact members financially, it is important to note that they exist to protect the scheme from selective abuse.    

Makoti Late Joiner Fees Frequently Asked Questions

What are late joiner fees for Makoti Medical Scheme?

Members who join Makoti Medical Scheme after 35 and have not been continuously enrolled in another registered medical scheme for at least 24 months must pay late joiner fees. The fees are meant to deter people from joining the program only when they need medical care and encourage them to join earlier in life.  

How does Makoti Medical Scheme calculate late joiner fees?

Late joiner fees for Makoti Medical Scheme are based on the percentage of the monthly contribution that the member has been without medical scheme cover since turning 21. Therefore, the percentage rises each year a person goes without health insurance.  

What are the waiting periods for Makoti Medical Scheme?

Makoti Medical Scheme’s waiting periods change depending on the member’s chosen plan. Conditions at enrollment, those that persist over time, maternity benefits, and some optional procedures may all be subject to waiting periods.  

What medical conditions are typically subject to waiting periods for Makoti Medical Scheme?

Pre-existing conditions, chronic conditions, maternity benefits, and certain elective procedures are all examples of Makoti Medical Scheme cover that may be subject to a waiting period.  

Can late joiner fees for Makoti Medical Scheme be waived?

Members of Makoti Medical Scheme who can provide proof of prior medical scheme coverage or who are exempt from paying the fees due to special circumstances, such as financial hardship, may have their late joiner fees waived.  

How can I minimize healthcare costs with Makoti Medical Scheme?

Choose a plan that fits your needs, take advantage of preventive care services, use generic medications, and see doctors in the Makoti Medical Scheme network to keep costs down.