The benefits on your medical aid are not immediately accessible once you sign up for cover. This applies to all benefits, including pregnancy and childbirth benefits. You have to wait for a period of time despite paying your monthly contribution. These measures are intended to protect the scheme and members from consumers who join a scheme only to use benefits and terminate membership thereafter. It is therefore important to get cover early in life as possible and overcome these delays to ensure you have adequate cover when you need it.
What is a waiting period?
As the name suggests, a waiting period is time that has to elapse before cover becomes active. With medical aid there are two such types of waiting periods for maternity benefits. The first is the 3 month general waiting period and the second is the 12 month pre-existing waiting period. While the 3 month waiting period applies to all members, the second waiting period only applies in certain instances to some new joiners of a scheme. It is a mandatory period of time that has to pass and applies to many other financial products, not only medical aid.
If you are a new member on a medical aid and already paying premiums, you should not be misled into believing that you can immediately start using your cover. The waiting periods are in place for good reason, although new members sometimes feel that it is unfair. In the long run these waiting periods protect the financial resources of the scheme, which in turn protects you as the member. It also means that you should not wait to till the last minute to join a medical aid. If you are ill and need cover, then you will have to wait till this period of time passes.
3 Month Waiting Period
The 3 month waiting period applies to all benefits, be it out-of-hospital, chronic or in-hospital. During this time you will not be able to use your medical aid. You will still have to pay the premiums from month one but you cannot use the cover. This waiting period falls away if the member has moved from one scheme to another. In other words you were already a medical aid member and simply switched your cover to another scheme. However, it is important that there should be no break in you cover as it can bring waiting periods back into the equation.
Be careful about falling pregnant during this time. If you think that you will only need cover for your pregnancy or childbirth after this period then you may fall into the 12 month pre-existing period as well. Pregnancy lasts for 40 weeks, approximately 9 months, if you fall pregnant within a few days of cover then the medical aid may still dispute cover for childbirth even after you pass the 3 month waiting period. Many women do not disclose pregnancy after discovering it at a very early stage. Therefore medical aids are cautious.
12 Month Waiting Period
The 12 month waiting period is known as the pre-existing condition(s) waiting period. It applies for all conditions, including pregnancy, and not just diseases. Many members are unaware that it applies to medical conditions. Pregnancy is not a disease but it is a medical condition. So it is subject to the same 12 month waiting period as diseases. No exceptions are made in these cases. Any woman who is pregnant at the time of joining a medical aid will not have the current pregnancy and childbirth costs covered as per the 12 month pre-existing condition waiting period. It is further explained under medical aid for already pregnant women.
There are many instances on an almost daily basis where new members do not reveal that they are pregnant at the time. It may be very early in the pregnancy and they plan to inform the scheme after signing up for cover. Remember that baby has to be delivered by around 40 weeks, so there is no way to wait for this 12 month period to bypass. The scheme will be able to assess the approximate date of pregnancy and refuse to pay for the bills if it deems it to have been a pre-existing condition. However, all future pregnancies after the 12 month period will be covered.