One of the most important aspects for first time buyers of hospital plans is to understand the waiting periods thoroughly at the outset. You may be surprised to find that you are caught out without cover by not having properly understood all aspects of waiting periods for hospital plans. The fact of the matter is that there is no immediate cover for any type of hospital plan, be it the hospital cash back plan or a medical aid hospital plan. You will have to wait for a period of time before your cover will payout.

What does waiting period mean?

Firstly hospital cash back plans and medical aid hospital plans are two separate products. Both have waiting periods which may apply differently. A waiting period for any type of cover means that there is a time span during which your cover will not payout for a claim despite you paying the premiums. The reason why waiting periods exist is to prevent new members from making a claim immediately. The reality is that there are many South Africans who do not wish to cover themselves until the very last minute.

Any type of cover works by pooling money together, payout out for some members on some months and other members on other months. And then there are the members who never claim despite loyally paying their premiums for months or years. Every time a claim is made, a certain amount of money is pulled out of the pool or reserves for the payout. It becomes unfair to loyal customer who never claim but loyally pay for cover to then be paying claims for new members who have not contributed more than one or two premiums.

The waiting period essentially protects your cover in the long term by detracting people who only sign up for cover to claim and then leave shortly thereafter.

Medical Aid Waiting Period

A medical aid has two waiting periods. Firstly there is a 3 month general waiting period against all claims. This means that for the first 3 months of paying your premiums you cannot claim for medical services. You are fully covered after this 3 month general waiting period passes. There is also a second waiting period known as the pre-existing condition waiting period. It lasts for the first 12 months of your cover. During this time you cannot claim for any medical expenses accrued due to any medical condition that you had prior to joining the hospital plan. It applies for diseases and even pregnancy.

There is no immediate cover on medical aid unless you are moving from one medical aid to another. As an existing medical aid member transferring your membership to another medical scheme, these waiting periods fall away. But for first time medical aid members the waiting periods cannot be waived for any reason. It is not discriminatory. It is simply the way the scheme protects its long-standing medical aid members.

Hospital Cash Plan Waiting Period

A hospital cash back plan is an insurance policy that pays out for each day that you are hospitalised. It is not a medical aid but a waiting period still applies to this type of cover. The period may vary among different insurers but usually it applies to the first 6 to 12 months of cover. This means you will still have to pay your hospital cash back cover premiums but you are unable to lay a claim. There may be certain concessions in terms of hospitalisation for accidents but this is dependent on the insurer and level of cover.

The best way to look at hospital plan waiting periods is that it is a probationary period. You would never buy car insurance only after having a road traffic accident. Similarly you should not buy hospital cover only when you need it. Rather buy hospital cover while you are still young and healthy and you will reap the benefits at your time of need.