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 | 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 2022 to January 2024. 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 2025 and currently still a member. Spouse was diagnosed with raised cholesterol in September 2025, currently on treatment.
Decision: 12-month hypercholesterolaemia waiting period for spouse. No LJP.
48-year-old principal member. Joined previous scheme on 1 September 2025 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 2026 therefore 9 months still apply). 25% LJP.
38-year-old principal member. Joined previous scheme in October 2023 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 2020 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 2000 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.