Checklists
Questions to ask before joining a medical aid scheme
By Naledi Mokoena · 6 min read · Updated 24 June 2026
Before you join a medical aid, ask about waiting periods, late-joiner penalties, the hospital rate the plan pays, the network rules, chronic and PMB cover, and the co-payments. The right questions upfront stop nasty surprises at your first big claim, when it is too late to change plans.
Use this list of questions with the scheme or broker before you sign anything.
Get the answers in writing. A verbal promise from a sales agent is hard to enforce later.
Waiting periods and penalties
Ask:
- Will I have a general waiting period (up to three months) or a condition-specific one (up to 12 months)?
- Will my membership certificate from my old scheme waive any waiting periods?
- Will a late-joiner penalty apply because of my age or a past break in cover, and how much?
Late-joiner penalties are permanent, so this matters if you are joining later in life.
What the plan actually pays
Ask:
- At what rate does the plan pay in hospital - 100%, 200% or 300% of scheme rate?
- What co-payments apply to scopes, scans, joint and other procedures?
- Is there day-to-day cover, and is it savings or an above-threshold benefit?
- What are the per-category sub-limits for dentistry, optical and specialists?
These answers tell you what you will pay out of pocket when you claim.
Networks and providers
Ask:
- Is this a network plan, and which hospitals, doctors and pharmacies must I use?
- Is my current GP or specialist in the network?
- What happens, and what does it cost, if I use a non-network provider?
- Who is the designated service provider for chronic medicine and PMBs?
A cheaper network plan is only cheap if your providers are in the network.
Chronic, PMB and maternity
Ask:
- Which chronic conditions are covered, and is my medicine on the formulary?
- How are prescribed minimum benefits handled, and through which provider?
- What are the maternity benefits and any waiting period if I am planning a family?
- How do I register chronic medicine, and from when will it be funded in full?
These confirm the cover you most rely on is actually there when you need it.
Frequently asked questions
What should I ask before joining a medical aid?
Ask about waiting periods, late-joiner penalties, the hospital rate the plan pays, network rules, co-payments, and chronic and PMB cover. Get the answers in writing so a sales promise can be held to later if there is a dispute.
What is a late-joiner penalty?
It is a permanent surcharge on your contribution that schemes may apply if you join after age 35 without continuous prior cover. The longer you were without cover, the higher it is. Ask whether one applies before you join.
How do I avoid waiting periods when I join?
Move across from another scheme with no break in cover and supply your membership certificate. That can waive general and condition-specific waiting periods. A gap in cover usually means you serve fresh waiting periods.
Why does the hospital rate matter so much?
It sets how much of a specialist's bill the plan pays. A plan paying 100% of scheme rate can leave a large shortfall when specialists charge 200% or 300%. Ask the rate, and consider gap cover if it is only 100%.
Should I get answers in writing?
Yes. Verbal promises from a sales agent are hard to enforce. Ask for the benefit brochure and written confirmation of waiting periods, penalties and co-payments before you sign, so you have proof if a claim is disputed later.
What chronic questions should I ask?
Ask which chronic conditions are covered, whether your medicine is on the formulary, who the designated pharmacy is, and how to register chronic cover so it is funded in full from the start rather than off your savings.
