Joining a medical aid is one of the best financial decisions you can make for your health — but what happens if you fall ill shortly after signing up and find that your claim is declined? For many South Africans, this is the frustrating reality of medical aid waiting periods, and it often comes as a complete surprise.
Waiting periods are a standard feature of medical aid membership in South Africa, permitted under the Medical Schemes Act No. 131 of 1998. Understanding how they work, why they exist, and when they can be waived will help you plan ahead and avoid being caught off guard when you need cover most.
In this guide, we cover everything you need to know about waiting periods — including how they apply specifically to Momentum Medical Aid, which Bloom offers in partnership with Momentum Medical Scheme.
What Is a Medical Aid Waiting Period?
A waiting period is a defined period of time, starting from the date your medical aid membership commences, during which you pay your monthly contributions but may not claim certain benefits from the scheme.
Waiting periods are not an invention of individual schemes — they are a provision explicitly permitted by the Medical Schemes Act No. 131 of 1998, which governs all registered medical schemes in South Africa. The Council for Medical Schemes (CMS), the statutory body that regulates medical schemes, oversees the application of these rules.
What is a medical aid waiting period? A waiting period is the period after joining a registered South African medical scheme during which you cannot claim for certain benefits. There are two types: a 3-month general waiting period, and a 12-month condition-specific waiting period. Both are permitted under the Medical Schemes Act No. 131 of 1998.
Source: Council for Medical Schemes (CMS)
It is important to understand that not every new member will automatically receive a waiting period. Whether one is applied depends on your individual health history and your previous medical aid membership status.
The Two Types of Waiting Periods
Under the Medical Schemes Act, schemes may apply two distinct types of waiting periods:
| Type | What It Means |
| General Waiting Period (3 months) |
No claims may be submitted for any medical expenses during the first 3 months of membership. This applies to all benefits — from GP visits to hospitalisation. |
| Condition-Specific Waiting Period (12 months) |
Claims related to a specific pre-existing medical condition may not be submitted during the first 12 months of membership. All other benefits remain accessible once the general waiting period ends. |
Source: Medical Schemes Act No. 131 of 1998, Section 29A
The 3-Month General Waiting Period
During a general waiting period, you are unable to claim for any benefit from the scheme — including routine GP consultations, emergency care (where not classified as a Prescribed Minimum Benefit), and hospitalisation. Your monthly contributions are payable from day one.
This waiting period is most commonly applied to members who are joining a medical scheme for the very first time, or who have had a break in medical aid cover of more than 90 days.
The 12-Month Condition-Specific Waiting Period
A condition-specific waiting period targets pre-existing conditions — medical conditions that were diagnosed, treated, or for which symptoms were present before you joined the scheme. If a 12-month condition-specific waiting period is applied, you can still claim for all other benefits once your general waiting period has ended; you simply cannot claim for treatment relating to that specific condition during the 12-month window.
Examples of conditions that may attract a condition-specific waiting period include hypertension, diabetes, asthma, and orthopaedic conditions such as back problems or previous injuries requiring surgery.
What About Prescribed Minimum Benefits (PMBs) During a Waiting Period?
Even during a waiting period, registered medical schemes are legally required to provide access to Prescribed Minimum Benefits (PMBs). PMBs are a defined set of conditions and treatments that all schemes must cover, as mandated by the Medical Schemes Act.
However, during a waiting period, the scheme may direct you to a State facility for PMB-related treatment rather than a private hospital. You are not left entirely without a safety net during your waiting period, but the level of care and the facility may differ from what you would ordinarily access on your chosen plan.
For a full breakdown of what PMBs cover, read our article: Your Complete Guide to Prescribed Minimum Benefits.
Source: Momentum Medical Scheme FAQ, momentum.co.za
Momentum Medical Aid Waiting Periods: What You Need to Know
Bloom is proud to offer medical aid plans in partnership with Momentum Medical Scheme, one of South Africa’s most trusted and established medical aid schemes. Here is how Momentum Medical Scheme applies waiting periods to new members.
What is the waiting period for Momentum Medical Aid? In terms of the Medical Schemes Act, Momentum Medical Scheme may apply a 3-month general waiting period from the date your membership starts. A 12-month condition-specific waiting period may also be applied for pre-existing conditions. During either period, Prescribed Minimum Benefits may be accessed at a State facility.
Source: Momentum Medical Aid FAQs, momentum.co.za
Waiting periods are assessed on an individual basis and are not automatically applied to every new member. Momentum Medical Scheme evaluates each application according to the following factors:
- Whether you are joining a medical scheme for the first time
- Your current health status and any pre-existing conditions
- Whether there has been a lapse in your previous medical aid cover
- The length of time since your previous medical aid membership ended
Transparency is central to how Bloom operates. When you apply for a Momentum Medical Aid plan through Bloom, your consultant will walk you through the underwriting assessment and explain clearly whether any waiting periods apply to your specific situation — before you commit.
Why Does a 3-Month Waiting Period Exist?
Why is there a 3-month waiting period for medical aid? The 3-month general waiting period exists to protect the medical scheme’s risk pool from adverse selection — where individuals join specifically to claim for a known condition and then cancel their membership. It keeps monthly contributions manageable for all members and ensures the fund remains financially sustainable.
South African medical schemes operate on a community rating model, which means all members on the same plan pay the same monthly contribution, regardless of their age or health status. This is fundamentally different from short-term insurance, where premiums are priced according to individual risk.
The trade-off for this community-rated, open-enrolment model — where schemes must accept all applicants — is that schemes need protection against people who join only when they require expensive treatment. Without waiting periods, the scheme’s risk pool would be rapidly depleted by members who contribute for a short period, claim heavily, and then cancel.
Medical schemes are also required by the Council for Medical Schemes to maintain a minimum solvency reserve. Waiting periods help sustain those reserves and, by extension, the scheme’s ability to pay out claims for all members. In short, the waiting period ultimately benefits every member by keeping the fund financially sound.
How Does a Waiting Period Affect Your Benefits?
How does a waiting period affect benefits? During a general waiting period, you cannot claim for any benefits. During a condition-specific waiting period, only claims for that specific condition are excluded. Monthly contributions remain payable throughout, and Prescribed Minimum Benefits may still be accessible at a State facility.
Here is a practical overview of what you can and cannot access during each type of waiting period:
| Scenario | What This Means for You |
| During a 3-month general waiting period | You cannot claim for any medical benefits, including GP visits, specialist consultations, hospitalisation, chronic medication, or dental and optical cover. Monthly contributions are still payable in full. |
| During a 12-month condition-specific waiting period | You cannot claim for treatment related to the specified pre-existing condition only. All other benefits are accessible once the general waiting period (if any) has ended. |
| PMBs during any waiting period | Access to Prescribed Minimum Benefits is protected by law. However, the scheme may direct you to a State facility for treatment rather than a private provider. |
| After your waiting period ends | Full access to your plan’s benefits resumes. Any unused benefit limits from the waiting period are not carried over. |
Source: Discovery Health Medical Scheme Underwriting Guide; Medical Schemes Act No. 131 of 1998
One important point: your monthly premiums are payable from the day your membership starts, even during the waiting period. This is sometimes a source of frustration for new members, but those contributions go towards building the risk pool that funds claims for all scheme members, including your own future claims.
If you are concerned about the gap in cover during a waiting period, a short-term health insurance product may provide a temporary bridge while you wait for full benefits to activate. Speak to a Bloom consultant to discuss your options.
Can a Waiting Period Be Waived?
Can a medical aid waiting period be waived? Yes, in certain circumstances. If you join a new scheme within 90 days of leaving your previous scheme (no break in cover exceeding 90 days), a general waiting period may be waived. Condition-specific waiting periods may also be reduced if you can demonstrate continuous cover for that condition with a previous scheme.
There are several scenarios in which waiting periods may be reduced, waived, or transferred:
Transferring from Another Registered Scheme Without a BreakIf you are moving from one registered South African medical scheme to another and your new membership begins within 90 days of your previous membership ending, the general waiting period may be waived. The condition-specific waiting period may also be reduced based on the time already served on your previous scheme. To qualify, you will typically need to provide a membership certificate from your previous scheme as proof of continuous cover.
Employer Group MembershipSome employers have arrangements with medical schemes that allow employees to join without serving a waiting period, particularly during open enrolment periods. This is a benefit worth confirming with your HR department if you are joining through a workplace group scheme.
Adding a Newborn Within 90 Days of BirthBabies added to a medical aid scheme within 90 days of birth are typically covered immediately, without a waiting period. This is an important consideration for expecting parents.
Corporate and Employer-Sponsored Open Enrolment WindowsSome schemes have negotiated arrangements with corporate groups that reduce or waive waiting periods for members who join during a specific enrolment window.
The rules around waiting period waivers can be nuanced and depend on the specific scheme rules and your individual circumstances. A Bloom consultant can help you understand exactly what applies in your case.
Bloom’s Medical Aid Plans Through Momentum Medical Scheme
Through our partnership with Momentum Medical Scheme, Bloom offers three carefully structured medical aid options to suit a range of life stages and budgets. Each plan delivers a wide range of in- and out-of-hospital benefits, with access to a premium network of healthcare providers across South Africa.
| Plan | Starting From | Best For |
| Ingwe Option | R589 p/m | First-time earners, students, or those seeking affordable entry-level cover. Includes hospital cover, day-to-day benefits, and chronic illness benefits when using network providers. |
| Evolve Option | R1,847 p/m | Digitally savvy individuals wanting affordable hospital cover and virtual GP consultations, including access to HelloDoctor and 2 virtual GP consultations per year. |
| Custom Option | R2,353 p/m | Comprehensive hospitalisation cover without an overall annual limit, with access to private hospitals, preventative screenings, and customisable savings via HealthSaver+. |
Source: Bloom Medical Aid — bloom.insure/medical-aid/. Waiting periods may apply when joining any of these plans, depending on your individual circumstances.
Compare all Bloom medical aid options →
Our consultants at Bloom are ready to help. We’ll walk you through your options, explain any waiting periods that may apply, and make sure you’re covered with a plan that suits your life and budget — in plain English, with no pressure.
Frequently Asked Questions
What is the waiting period for Momentum Medical Aid?
Momentum Medical Scheme may apply a 3-month general waiting period from the date your membership commences. A 12-month condition-specific waiting period may also apply to pre-existing conditions. During either period, Prescribed Minimum Benefits (PMBs) remain accessible, though treatment may be directed to a State facility. Waiting periods are assessed individually and are not automatically applied to every new member.
Source: Momentum Medical Aid FAQs, momentum.co.za
Why is there a 3-month waiting period for medical aid?
The 3-month general waiting period protects the medical scheme’s risk pool from adverse selection — a situation where people join specifically to claim for treatment and then cancel their membership. Medical schemes in South Africa operate on a community-rated model where all members pay the same contribution, making the scheme vulnerable to this kind of exploitation. Waiting periods are one of the few tools the Medical Schemes Act permits schemes to use to remain financially sustainable for all members.
How does a waiting period affect benefits?
During a 3-month general waiting period, you cannot claim for any medical benefit. During a 12-month condition-specific waiting period, only claims relating to the specified pre-existing condition are excluded — all other benefits remain accessible once the general period has ended. Your monthly contributions are payable throughout, and Prescribed Minimum Benefits may still be accessed at a State facility during the waiting period.
Can a medical aid waiting period be waived?
Yes, in certain circumstances. If you transfer from one registered South African medical scheme to another with no break in cover exceeding 90 days, the general waiting period may be waived. Condition-specific waiting periods may be reduced based on time already served with a previous scheme. Waiting periods may also be waived for employees joining through qualifying employer group arrangements, and for newborns added within 90 days of birth.
How long is the waiting period for medical aid in South Africa?
Under the Medical Schemes Act No. 131 of 1998, medical schemes may apply a general waiting period of 3 months and/or a condition-specific waiting period of 12 months. Whether either applies depends on your individual circumstances. If you transfer from another scheme without a break in cover, waiting periods may be reduced or waived entirely.
Do I still pay contributions during the waiting period?
Yes. Monthly contributions are payable from the first day of membership, even if you are serving a waiting period. This is a standard requirement under the Medical Schemes Act. Your contributions go into the scheme’s risk pool, which funds claims for all members, including your own future claims.
This article is provided for general information purposes only and does not constitute financial, legal, or medical advice. Waiting period rules may vary depending on your individual circumstances and the specific plan you select. Terms and conditions apply. Please speak to a Bloom consultant for advice tailored to your personal situation. Bloom acts as an authorised intermediary. Momentum Medical Scheme is a registered medical scheme (Reg. No. 1195). The Medical Schemes Act No. 131 of 1998 governs the rules applicable to medical scheme waiting periods in South Africa.
