Medihelp Late Joiner Fee 🇿🇦(2025*)

Overall, Medihelp is a trustworthy and comprehensive medical aid provider. New Members 35 years or older may be subject to late-joiner penalties on Medihelp Medical Aid Plans. The Medihelp Medical Aid Plans start from R750 ZAR per month. Medihelp has a trust rating of 4.2.

Medihelp Late Joiner Fees – 9 Key Point Quick Overview

1. ✅ Medihelp Late Joiner Fees – What to know before Joining
2. ✅ Medihelp Waiting Periods
3. ✅ Medihelp Exclusions
4. ✅ Medihelp 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 Medihelp Late Joiner Fees
9. ✅ Medihelp Late Joiner Fees Frequently Asked Questions

Medihelp Late Joiner Fees – What to know before Joining

Medihelp imposes late joiner fees on new members who have never been part of a medical scheme before or have had prolonged breaks in medical scheme cover. The late joiner fees are a penalty imposed by the Medical Schemes Act on applicants who are 35 years or older when joining Medihelp and have not had previous medical scheme cover.

The penalty is calculated as a percentage of the member’s monthly contribution based on the total number of years without creditable cover since the age of 35 years. This penalty is added to the member’s monthly contribution.

Furthermore, members can find the penalties below:

Medihelp Waiting Periods

During waiting periods, members are eligible for membership but not for benefits.

For example, Medihelp could implement either a general or condition-specific waiting period as follows:

• ✅ The general waiting period is up to three months from the date of membership. During this time, you will not be eligible for benefits other than the minimum prescribed benefits (PMB). During this waiting period, the Scheme will not pay any claims you file.
• ✅ From the day you join, a condition-specific waiting period of up to 12 months applies. During this period, you will not be eligible for benefits related to a specific ailment for which you get medical advice, a diagnosis, care, or treatment (this excludes PMB).

More information regarding Waiting periods will be made available by Medihelp.

Medihelp Exclusions

Each year, as medical research progresses, new medical services are introduced. However, Medihelp prioritizes cover for life-saving medical care.  The Medical Schemes Act mandates that medical plans cover the diagnostic, treatment, and care costs of the mandated minimum benefits (PMB) without co-payments or deductibles.  In addition, services must adhere to the PMB treatment algorithms mandated by law and the managed healthcare guidelines of Medihelp, which may include pharmaceutical formularies.

If a protocol or formulary drug is ineffective or hazardous, Medihelp will cover the cost of substitute treatment.

Nonetheless, Medihelp’s exclusions include, but are not limited to, the following:

• ✅ Restorative fillings for teeth injured by toothbrush abrasion, attrition, erosion, and fluorosis
• ✅ Resin bonding for restorations is billed separately from the restoration
• ✅ The polishing of restorations
• ✅ Gold foil embellishments
• ✅ Ozone therapy Diagnostic dentures and laboratory fees
• ✅ Snoring aids and accompanying laboratory expenses
• ✅ Provisional dentures and corresponding laboratory fees
• ✅ Implants for third molars
• ✅ Dolder bars and accompanying implant abutments, including laboratory costs
• ✅ Fees for laboratory delivery
• ✅ Cosmetic orthodontic treatment and accompanying laboratory expenses
• ✅ Orthodontic treatment for those aged 18 and older
• ✅ Surgical periodontics, including gingivectomies, periodontal flap surgery, tissue grafting, and tooth hemisection

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

Medihelp 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 Medihelp, 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 Medihelp Late Joiner Fees

Overall, Medihelp’s late joiner fees can be both a benefit and a drawback for new members. On the one hand, the fees are a requirement of the Medical Schemes Act and help ensure that the scheme is financially sustainable by compensating for the potentially higher costs of covering new members who may have pre-existing conditions.

However, the fees can also be a disadvantage for older people who have not had previous medical scheme cover, as the penalty can add a significant amount to their monthly contribution.

One benefit of Medihelp’s late joiner fees is that they can help ensure the scheme can cover the costs of pre-existing conditions for new members. This can be especially important for older members who may be more likely to have health issues that require medical attention. Additionally, Medihelp offers its members a range of benefits and services, including access to a network of healthcare providers and various wellness programs. Members can also choose from various benefits to suit their healthcare needs and budget.

However, it is important for prospective members to carefully review the terms and conditions of their chosen benefit option, as some may have limitations or exclusions that could impact their healthcare coverage.

Medihelp Late Joiner Fees Frequently Asked Questions

What is Medihelp’s late joiner penalty?

Medihelp’s late joiner penalty is a once-off fee charged to members who join the scheme after 35 and have not had continuous membership with a registered medical scheme for at least 24 months. Furthermore, the penalty is calculated as a percentage of the member’s monthly contribution. Therefore, it is added to the monthly contribution for the first three years of membership.

How are waiting periods calculated for new members of Medihelp?

Waiting periods for new members of Medihelp are calculated based on the date of membership and the type of benefit being claimed. For example, the waiting period for pre-existing conditions is 12 months. In comparison, the waiting period for hospitalization and certain other benefits is three months.

Can I avoid the Medihelp late joiner penalty?

Yes, you can avoid the Medihelp late joiner penalty by joining a registered medical scheme before 35 and maintaining continuous membership for at least 24 months. If you are a member of a registered medical scheme and you switch to Medihelp within 90 days of leaving your previous scheme, you will not be liable for the late joiner penalty.

How much is the Medihelp late joiner penalty?

The Medihelp late joiner penalty is calculated as a member’s monthly contribution percentage. It is added to the monthly contribution for the first three years of membership. After that, the percentage varies depending on the number of years that the member has been without medical scheme cover.

What happens if I cannot afford to pay the Medihelp late joiner penalty?

If you cannot afford to pay the Medihelp late joiner penalty, you may be eligible for a reduced penalty or an exemption. To apply for a reduced penalty or exemption, you must complete a financial assessment form and provide supporting documents to prove that you cannot pay the full penalty.

What benefits does Medihelp offer?

Medihelp offers various benefits, including hospitalization, chronic medication, preventative care, maternity benefits, and dental benefits. The specific benefits available to members depend on the plan they choose.

How do I become a member of Medihelp?

To become a member of Medihelp, you can visit their website and complete an online application form. Alternatively, you can contact their call center, and a representative will assist you with the application process.

Does Medihelp cover chronic medication?

Yes, Medihelp covers chronic medication for members diagnosed with a chronic condition listed on their chronic disease list. Members may need to obtain prior authorization for certain medications.

How are tariffs determined for medical services provided by Medihelp’s network of healthcare providers?

Tariffs for medical services provided by Medihelp’s network of healthcare providers are negotiated between the scheme and the provider. The tariffs are based on factors such as the cost of providing the service, the complexity of the procedure, and the prevailing market rates.