Underwriting summary 2025

 

Underwriting Summary 

 

Individuals
Compulsory group
Super group
Group size

1 member

2 to 9 principal members

10 or more principal members

Underwriting

Individual medical underwriting

Group medical underwriting

Demographic underwriting

Underwriting decision

12-month condition specific waiting periods

3-month general waiting period

Late joiner penalties

Group decision subject to qualification criteria

Group decision subject to qualification criteria

Application form

Individual application for membership

Individual application for membership

Super Group application for membership

Requirements for decision

Fully completed application form

Fully completed application form for each member

Demographics of group using the Health Import Template


Waiting periods

 
Type 1
Type 2
Type 3

No previous cover or more than a 
 3-month break in cover from previous medical scheme

Less than 2 years continuous cover with less than a 3-month break in cover from previous medical scheme

More than 2 years continuous cover with less than 3-month break in cover from previous medical scheme

Waiting periods

12-month condition specific waiting periods

3-month general waiting period

12-month condition specific waiting period for newly diagnosed conditions 
 Balance of any waiting periods still active from previous scheme

3-month general waiting period

Prescribed Minimum Benefits

Not eligible for cover of Prescribed Minimum Benefits

Eligible for cover of Prescribed Minimum Benefits

Eligible for cover of Prescribed Minimum Benefits

 

Transferring from a closed or restricted scheme

If an applicant is moving from a closed or restricted scheme due to change of employment with less than 3 months’ break in cover, no waiting periods may be applied by Momentum Medical Scheme.

 

 

Late Joiner Penalties

A late joiner is an applicant or dependant, who at time of application with Momentum Medical Scheme:

  • is 35 years or older,
  • was not a member of a registered medical scheme on or before 1 April 2001, or
  • has allowed more than 3 months break in membership since 1 April 2001.

 

Years not covered on a previous medical scheme from age 35 onwards
Late joiner penalty (LJP)

1 - 4 years

5%

5 - 14 years

25%

15 - 24 years

50%

25+ years

75%

 

Type 1

28-year-old single principal member. No previous medical scheme cover. Irritable bowel syndrome on treatment.

Decision: 12-month irritable bowel syndrome waiting period. No LJP.

 

39-year-old principal member, 41-year-old spouse. Previously on Fedhealth from April 2002 to January 2008. Principal member had gall bladder removed 8 years ago due to gallstones - fully recovered.

Decision: No waiting periods. No LJP.

 

58-year-old principal member. No previous medical scheme cover. Hypertension on treatment. Diabetes on treatment. Coronary artery bypass done 2 years ago, following heart attack while on treatment.

Decision: 12-month hypertension, diabetes and coronary artery disease waiting periods. 3-month general waiting period. 50% LJP.

 

Type 2

23-year-old principal member, 31-year-old spouse. Joined previous scheme in July 2014 and currently still a member. Spouse was diagnosed with raised cholesterol in September 2015, currently on treatment.

Decision: 12-month hypercholesterolaemia waiting period for spouse. No LJP.

 

48-year-old principal member. Joined previous scheme on 1 September 2015 and currently still a member – previous scheme placed 12-month waiting period for arthritis.

Decision: Balance of 12-month arthritis waiting period (joining Momentum Medical Scheme on 
 1 January 2016 therefore 8 months still apply). 25% LJP.

 

38-year-old principal member. Joined previous scheme in October 2014 and currently still a member - previous scheme placed 12-month waiting period for epilepsy. No other conditions disclosed.

Decision: No waiting periods. No LJP.

 

Type 3

49-year-old principal member, 37-year-old spouse. Joined previous scheme in January 2008 and currently still a member. Principal member has hiatus hernia, currently on treatment.

Decision: No waiting periods. 25% LJP on principal member. No LJP on spouse.

 

51-year-old principal member. Joined previous scheme in June 1999 and currently still a member. Had mastectomy for breast cancer 2 years ago, currently on treatment. Depression currently on treatment.

Decision: 3-month general waiting period. No LJP.

 

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