Medical aid late-joiner penalty calculator
Your band under Regulation 13
| 1–4 years | 0.05 × contribution |
| 5–14 years ← you | 0.25 × contribution |
| 15–24 years | 0.5 × contribution |
| 25 or more years | 0.75 × contribution |
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Indicative: these are the legal maximums. Each scheme's rules say what it actually applies, so ask the scheme for its figure in writing. If you later prove more years of cover, the scheme must recalculate the penalty from then on (Regulation 13(4)); a sworn affidavit is accepted when papers cannot be found.
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Who is a late joiner
Regulation 11 of the Medical Schemes Act Regulations defines a late joiner as an applicant, or an adult dependant, who is 35 or older on the date of application. It excludes anyone covered by one or more medical schemes since before 1 April 2001 without a break of more than three consecutive months.
Creditable coverage — the years that reduce the penalty — means any period as a member or dependant of a medical scheme, of an entity that was exempt from the Act, of the SANDF medical cover for uniformed employees, or of the Permanent Force Continuation Fund, excluding years as a dependant under 21.
The formula and the bands
Regulation 13(3): A = B − (35 + C), where B is your age at application and C the years of creditable coverage you can demonstrate. A falls in one of the bands of Regulation 13(2):
| A (years) | Maximum penalty |
|---|---|
| 1 – 4 | 0.05 × contribution (5%) |
| 5 – 14 | 0.25 × contribution (25%) |
| 15 – 24 | 0.5 × contribution (50%) |
| 25 or more | 0.75 × contribution (75%) |
The penalty applies only to the part of the contribution for the late joiner — not to the rest of the family (Regulation 13(1)). It may follow you when you move to another scheme (Regulation 13(5)).
Worked examples
- Age 45, 2 years of earlier cover: A = 45 − (35 + 2) = 8 → band 5–14 → at most 25%. On a R3,000 monthly contribution for you, that is up to R750 more a month.
- Age 52, never on medical aid: A = 52 − 35 = 17 → band 15–24 → at most 50%.
- Age 40, 6 years of cover as an adult: A = 40 − (35 + 6) = −1 → no penalty.
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Frequently asked questions
How is the medical aid late-joiner penalty calculated?
A = your age when you apply − (35 + years of creditable coverage). A of 1–4 allows up to 5% of the contribution, 5–14 up to 25%, 15–24 up to 50% and 25 or more up to 75% (Regulation 13).
At what age does the late-joiner penalty apply?
From 35. People under 35 when they apply are not late joiners (Regulation 11).
Is the late-joiner penalty permanent?
The regulations do not set an end date, and the penalty may continue if you transfer to another scheme (Regulation 13(5)). It must be recalculated if you later prove more years of cover (Regulation 13(4)).
Does the penalty apply to my whole family's contribution?
No. It applies only to the portion of the contribution for the member or adult dependant who qualifies as a late joiner (Regulation 13(1)).
Do years as a child dependant count?
Years as a dependant under the age of 21 are excluded from creditable coverage; years as a dependant from 21 count.