Frequently Asked Questions

What is a general waiting period?

Medical Schemes may impose a general waiting period of three months on all benefits in respect of all new applicants and dependants who:

• have not belonged to a previous medical scheme for more than 90 days prior to joining a new medical scheme; or
• were members of another medical scheme for a period of more than 2 years, and joined a new medical scheme within 90 days of leaving their previous medical scheme.No benefits are payable during this period, not even if funded from a savings account, except in respect to any treatment of diagnostic procedures covered within the Prescribed Minimum Benefits (PMB’s).

What is a condition-specific waiting period?

Medical schemes may further impose a condition-specific waiting period of up to 12 months from the inception date of your membership, in respect of any pre-existing condition, in respect of any beneficiaries who:

• have not belonged to a previous medical scheme for more than 90 days prior to joining another medical scheme; or
• have belonged to a medical scheme for less than 2 years, and joined a new medical scheme within 90 days of leaving their previous medical scheme.

What is Non Disclosure?

There is a LEGAL requirement to tell a Medical Scheme (on joining) about any:

• Current conditions and/or treatments
• Previous conditions and/or treatments
• Planned procedures and/or treatments

Failure to disclose can lead to Termination of Benefits and/or Membership so please make sure that you do not leave anything off your application form even if you think it is something small.  Speak to a MediTrust advisor for more detail.

Where do I complain if claims are not paid timeously or when I am dissatisfied with a decision taken by the Scheme?

Any complaint must first be lodged with the scheme concerned. Written complaints would certainly be preferable, but all schemes should also have dedicated telephone lines to handle everyday complaints and enquiries. All schemes are also required to have independent disputes committees where members' disputes may be settled. Members and or their legal representatives may be present at disputes committee meetings to present their arguments. Legal representation is not obligatory. Should all efforts fail to resolve an issue with your scheme, you can submit your complaint to the Council for medical Schemes Complaints Unit.  Meditrust can assist you in this matter, we have a high success rate in settling our clients’ claims.