Benefits & claims
Waiting periods and exclusions on medical aid
By Naledi Mokoena · 5 min read · Updated 24 June 2026
A waiting period is a set time after you join when you pay contributions but cannot claim for certain care, while an exclusion is a treatment the plan never covers. South African law allows a general waiting period of up to 3 months and a condition-specific waiting period of up to 12 months for a pre-existing condition.
These rules are legal and apply to most new members. The good news is that prior continuous membership can reduce or remove them, and PMBs and emergencies are protected in important ways. This guide explains both so you know exactly when you can claim.
The two legal waiting periods
Schemes may apply, at most:
- A general waiting period of up to 3 months. You pay contributions but cannot claim for non-PMB care during this time.
- A condition-specific waiting period of up to 12 months for a condition you had before joining (a pre-existing condition).
A scheme can apply one or both, but never longer than these maximums.
When waiting periods are reduced
If you move from another scheme with no break longer than 90 days, the new scheme's ability to impose waiting periods is limited:
- More than 2 years continuous prior membership: only a condition-specific wait may apply, not a general one.
- Less than 2 years: the scheme can apply a general wait but must offset time already served.
Always give the new scheme your membership certificate as proof.
PMBs during a waiting period
This is important: even during a waiting period, the scheme must still cover emergencies and certain PMB care. A waiting period mainly affects non-PMB claims. So if a serious PMB event happens soon after joining, you are not left fully exposed. Confirm the specifics with your scheme.
Exclusions are different
An exclusion is care the plan simply does not cover, ever - not just delayed. Common examples are cosmetic surgery, some elective procedures, and treatments not clinically necessary. Exclusions are listed in your plan rules. Read them before you join, because an exclusion will not disappear after 12 months the way a waiting period does.
Frequently asked questions
How long are medical aid waiting periods?
By law, a general waiting period can be up to 3 months and a condition-specific waiting period up to 12 months for a pre-existing condition. A scheme cannot exceed these limits.
Can I avoid waiting periods?
Often yes, if you switch from another scheme with no break longer than 90 days. With over 2 years of continuous prior membership, a general waiting period cannot be applied.
Are emergencies covered during a waiting period?
Yes. Emergencies and certain PMB care must still be covered even while a general waiting period applies. Waiting periods mainly affect non-PMB, non-emergency claims.
What is the difference between a waiting period and an exclusion?
A waiting period is temporary - cover starts after it ends. An exclusion is permanent - that treatment is never covered on the plan. Check your plan rules for both.
Does a hospital plan have waiting periods?
Yes. Waiting periods apply to most new members on any plan type, including hospital plans, unless reduced by continuous prior membership.
Is a late-joiner penalty the same as a waiting period?
No. A waiting period is temporary; a late-joiner penalty is a permanent contribution loading for joining after age 35. See our late-joiner penalty guide for detail.
