How waiting periods work
A
waiting period is a set amount of time during which
members pay contributions but are not entitled
to any benefits during this time, except for PMB
conditions in some instances.
There are two types of waiting periods
A general waiting period can last up to 3 months. A beneficiary
is not entitled to any benefits (in some instances not even
PMBs) during this period. If a beneficiary submits claims during
a general waiting period, they will not be paid.
A condition-specific waiting period can last up to 12 months.
During this time a beneficiary is not entitled to any benefits for
a particular condition for which medical advice, diagnosis, care
or treatment was recommended or received.
When do waiting periods apply?
Waiting periods generally apply if you or your dependants
were not on a medical aid for a period of at least 90 days
before you joined Bonitas, if you have never been a member
of a medical aid or if you chose to move from another medical
aid to Bonitas.
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Waiting periods will not apply:
• To children born during membership; as long as they
are registered within 30 days of birth.
• If application is made to register a foster child or
adopted child dependant within 3 months of the date
on which fostership or adoption was granted.
• If application is made to register a spouse within 3
months of marriage.
• To a main member who is forced to join Bonitas due to
a change in employment.
• If your employer moves to another medical aid and the
change is made within a 90-day period.
Why do medical schemes apply waiting periods?
Waiting periods affect the richness of the benefits we offer,
premium increases and our solvency ratio. They are designed
to protect existing members while being fair to new members.
By law, open medical aids like Bonitas are not allowed to turn
away any person who wants to join, unless they are already
registered as a member on another medical aid. Waiting
periods prevent members who may be high claimers when
joining from receiving benefits in excess of what they have
contributed.
Bonitas Member Magazine 2016 Issue 1