Underwriting

What is underwriting?
Depending on your previous medical scheme history, a scheme can apply 'underwriting' on a new membership. This means that, according to regulation (Medical Schemes Act), schemes are allowed to impose a three-month general waiting period and/or a twelve-month waiting period on an existing condition. A Late Joiner Penalty can also be applied. The Scheme will consider underwriting if an employee does not join the Scheme within 30 days of commencement of employment.

Category A
Applicants who have had no previous medical cover or have allowed more than 90 days break between their previous scheme and date of application to the Anglo Medical Scheme will have the following imposed:

• A mandatory three-month general waiting period (GWP)
• A 12-month condition specific waiting period (CSWP)
• Late Joiner Penalties (LJP) should not apply unless confirmed by the Management Committee
• Members do not have access to Prescribed Minimum Benefits (PMB) cover during their waiting periods.

Category B
Applicants who have had less than two years' cover and less than 90 days break between their previous scheme and date of application to the Anglo Medical Scheme will have the following imposed:

• A 12-month condition specific waiting period (CSWP) and/or the balance of a previous waiting period
• Late Joiner Penalties (LJP) should not apply unless confirmed by the Management Committee
• Members have access to PMB cover during their waiting periods.

Category C
Applicants who have had two years or more cover and less than 90 days break between their previous scheme and date of application to the Anglo Medical Scheme:

• No waiting periods to apply
• Late Joiner Penalties should not apply unless confirmed by the Management Committee.
• Members have access to PMB cover during their waiting periods.

AMS applies the following underwriting policies for new employees:

For new, eligible employees and their dependants who apply to join Anglo Medical Scheme within 30 days of employment, no underwriting will be applied, which means:

• No waiting periods for main member and dependants
• Late Joiner penalties are not applicable to any member and their dependants unless instructed by the Management Committee.
• Dependants are always subject to eligibility criteria even when joining with the main member who is a new employee - see eligibility table.
• The application form must be received within 30 days of the employment even if the date of commencement differs. If the application form is received later, the following applies:
  • Waiting period applicable to member and dependants
  • Late Joiner Penalty fees applicable to main member and dependants

Eligibility Criteria and Underwriting for existing employees:

Existing employees and their dependants moving from another scheme who meet the following criteria are free of underwriting under the following circumstances:

• Spouse (main member of another Scheme) has been retrenched or has resigned
• A certificate of previous membership is provided
• Dependants are subject to eligibility criteria - see eligibility table
• Date of Commencement (DOC) must be the first of the month following termination from the previous scheme.

Motivation must be submitted to the Scheme Office to exclude anti-selective behaviour. Anti-selection is when a member only joins the medical scheme when needed, without continually paying the appropriate contribution. Example, a member should have joined AMS when he/she started working, but only joins the Scheme when he/she is ill, to obtain access to benefit cover.

Existing employees who do not fulfil the above criteria the following applies:

• Waiting period applicable to member and dependants
• Late Joiner Penalty fees applicable to main member and dependants