Waiting Periods vs Late Joiner Penalties: What’s the Difference in Medical Aid?

So, you’ve finally decided to join a medical aid. Maybe you’ve landed a full-time gig, started a family, or just realised that private hospital bills are no joke. Whatever your reason, welcome! But if you’re joining a little later in life or after being uncovered for a while, you might bump into two confusing terms: waiting periods and late joiner penalties.

They both affect your medical aid benefits, sure, but they’re not the same thing. And knowing the difference can save you from some surprises (like paying for cover you can’t use yet, or lifelong extra fees). So, let’s investigate.

What is a Waiting Period?

A waiting period is exactly what it sounds like: a short stretch of time where you pay for medical aid, but can’t claim right away. Medical schemes use this time to prevent people from only signing up when they need treatment urgently, then cancelling once they’re sorted.

In South Africa, there are generally two types of waiting periods. The first is a general waiting period, which is always three months. During this time you can’t claim for anything unless it’s a medical emergency. You can also only get PMB cover during this period if you’ve had at least two years of medical aid previously and haven’t had a break in cover for more than 90 days. The second is a condition-specific waiting period, which lasts for 12 months and applies only to pre-existing conditions like diabetes, pregnancy, or a back injury you’ve had before joining.

When Does a Waiting Period Apply?

Waiting periods mostly affect first-time joiners or people who’ve had a break of more than 90 days in their medical aid membership. If you’ve had uninterrupted cover and you’re simply switching between plans, many providers might waive the waiting period altogether. But if you’ve gone without medical aid for a while, even just a few months, you can expect to wait before you can start claiming.

What is a Late Joiner Penalty?

The Medical Aid Late Joiner Penalty is a completely different kettle of fish. Unlike a waiting period, which is temporary, this one sticks with you for life. If you’re 35 or older and you’ve spent several adult years without medical aid, your provider can add a percentage-based penalty to your monthly risk premium. The older you are (and the longer you’ve been uncovered) the higher the penalty. That penalty follows you for life, no matter which medical aid scheme you switch to.

This rule exists because people tend to need more medical care as they age. If you’ve joined late but never contributed to the risk pool during your healthier, younger years, the penalty helps balance that out. It’s a way for medical schemes to stay financially sustainable.

To calculate how much the late-joiner penalty will be, the medical aid provider will take into account the number of years that you or your dependents have not been members of a registered South African medical scheme since the age of 35. This excludes any period of cover as a dependent under the age of 21.

A real-life example of Late Joiner Penalties: if you are 58 years old on the date of registration and you belonged to another medical scheme for 12 years, the following late-joiner penalty band would apply:

58 - (35 + 12) = 11 uncovered years, which will result in a 25% late-joiner penalty according to the table above.

Key Differences at a Glance

The main difference comes down to timing and impact. A Waiting Period is a temporary measure that affects when you can start claiming. It lasts between three and twelve months, depending on your health history and coverage record. In contrast, a Late Joiner Penalty affects what you pay, and it’s permanent. It only kicks in if you’re 35 or older and have had substantial gaps in your medical aid history.

How to Avoid These Pitfalls

The best way to avoid Late Joiner Penalties is to join a medical aid before you turn 35, or at least as soon as possible if you're already past that age. Even if you can’t afford a comprehensive plan, staying on a lower-tier option keeps your membership active and your risk profile intact. That means no penalties later on.

For Waiting Periods, your best bet is to maintain consistent cover. If you’ve been on a medical aid plan recently and are switching providers, some schemes will waive or reduce the waiting period. You will have PMB (life threatening emergency and chronic cover) during this period, depending on your current health status. It’s always worth checking this upfront before you sign any contracts.

Need Help Comparing Your Options?

Choosing a medical aid can feel like fighting your way through a jungle of paperwork – plans, terms, exclusions, waiting periods, penalties… it’s a lot. But you don’t have to do it alone. On hippo.co.za, you can compare medical aid plans from trusted providers side-by-side. You’ll see which schemes have waiting periods, what kind of medical aid penalties may apply, and which plans match your needs and budget.

Click. Compare. Get covered. Your future (healthy) self will thank you.