Kaya FM Interview – Wendy Bussey – 27th January 2022
When you join a medical scheme or gap cover, it is important to understand that waiting periods may apply to the cover. These depend on how long of a break there has been in your cover as well as how long you have had cover for, along with other factors. Understanding what waiting periods may apply, and importantly, why medical schemes and insurers have them, is key to making the most of your cover.
How are waiting periods imposed
Both medical schemes and gap cover providers can impose a three-month general waiting period and a 12-month condition-specific waiting period. The general waiting period means that there will be no cover for a period of three months, while the condition-specific waiting period means that the provider will not pay for costs associated with certain conditions, which will be specified up front when cover is taken out.
Waiting periods that are imposed depend on how long you have had medical scheme or gap cover, as well as how long the break has been in your cover. For example, if you have had a break in medical scheme cover of less than 90 days and the previous membership was longer than 24 months, then the maximum waiting period that can be imposed is a three-month general waiting period. During this time, you will still have access to cover for Prescribed Minimum Benefits (PMBs). However, if you have never had medical scheme cover, then this three-month general waiting period applies, and you will not have access to PMB cover. The 12-month condition-specific waiting period may also apply.
If you have been on a medical scheme for a continuous period of up to 24 months with a break of less than 90 days, you will also be subject the 12-month condition-specific waiting period except in respect of any treatment or diagnostic procedures covered within the prescribed minimum benefits
If a member has had a break in medical scheme membership of more than 90 days then there will be a 3-month general waiting period and condition specific waiting periods of up to 12 months and a member will not have access to treatment or diagnostic procedures covered within the prescribed minimum benefits while a member is within a waiting period.
Gap cover is slightly different, since it is short-term insurance Prescribed Minimum Benefits are not applicable, but providers can still apply a three-month general waiting period and 12-month condition-specific waiting periods for new members or members that have had a break in cover of more than 90 days. However, if you have been a member of gap cover and switch providers, they can only apply the balance of the 12-month waiting periods for benefits that you currently have and / or apply 12 month condition specific waiting periods to benefits that you did not previously have. In addition to this a 3 month general waiting period may also be imposed.
What is Gap Cover?
Turnberry assisted with claims for various incidents during the last few years – from an elective orthopaedic surgery for my young daughter to emergency surgeries for my wife. When my wife was diagnosed with cancer last year, the once-off payment assisted in a number of the out-of-hospital expenses. In addition, the knowledge that the expenses threshold is so much higher than the standard medical rates provided peace of mind. I have recommended Turnberry Gap Cover to our family, and reiterate that it is an essential or mandatory product. No healthy person believes critical or emergency procedures will happen. But the truth is that it can happen to anyone. The cost vs benefit is not a logical debate, without gap coverage you may end up selling assets to cover the bills. Turnberry’s services were professional, quick and efficient – ‘Peace of mind’. Mynhardt Oosthuizen – January 2022