Benefits & claims
The late-joiner penalty explained
By Naledi Mokoena · 5 min read · Updated 24 June 2026
- Triggers at
- Joining at age 35 or older with limited prior cover
- Nature
- Permanent loading on your contribution
- Based on
- Years without cover after age 35 (creditable years)
- Set by
- Medical Schemes Act regulations
A late-joiner penalty is a permanent extra amount added to your medical aid contribution if you join a scheme for the first time, or after a long gap, at age 35 or older. It is calculated from how many years you were not on a scheme after age 35, and it does not fall away.
The penalty exists to encourage people to join young and stay in. Because it is permanent, understanding it before you turn 35 can save you a lot of money. This guide explains how it is worked out and what counts in your favour.
How the penalty is calculated
The scheme counts your years of previous medical scheme membership (creditable cover) and compares them to your age. The number of uncovered years after age 35 puts you into a penalty band. Broadly, the more years you spent without cover after 35, the higher the band and the bigger the loading on your monthly contribution. The exact percentages are set in the regulations and applied by the scheme.
It is permanent
Unlike a waiting period, a late-joiner penalty does not expire. Once applied, it stays on your contribution for as long as you are a member, and it usually moves with you if you switch schemes. That is why it is so much more costly than a waiting period over a lifetime.
What counts as creditable cover
Creditable cover is time you were a member of a registered medical scheme (in some cases certain other recognised cover counts too). The more creditable years you can prove, the lower or smaller your penalty band. Keep membership certificates from every scheme you have ever belonged to, because they directly reduce the penalty.
How to avoid it
The simplest way to avoid the penalty is to join a scheme before age 35 and stay continuously covered. If you are already over 35 and have never joined, the penalty is unavoidable, but joining sooner stops more uncovered years from piling up. If you have prior membership you forgot to declare, give the scheme those certificates to recalculate.
Frequently asked questions
What is a late-joiner penalty?
It is a permanent extra amount added to your contribution if you join a medical scheme for the first time, or after a long gap, at age 35 or older. It is based on your uncovered years after 35.
At what age does the late-joiner penalty start?
It can apply when you join at age 35 or older without enough prior creditable cover. Joining before 35 and staying covered avoids it entirely.
Does the late-joiner penalty ever fall away?
No. It is permanent for as long as you remain a member and generally follows you if you change schemes. This is what makes it different from a temporary waiting period.
How is the penalty amount worked out?
The scheme counts your years without cover after age 35 and places you in a penalty band set by the regulations. More uncovered years means a higher loading on your contribution.
Can previous membership reduce my penalty?
Yes. Proven years of prior medical scheme membership (creditable cover) lower the penalty band. Submit certificates from every scheme you have belonged to so the scheme can recalculate.
Does switching schemes remove the penalty?
No. Switching schemes does not remove a late-joiner penalty. It generally transfers with you, so changing schemes will not escape it.
