What is medical aid?
Medical aid is a not-for-profit funding arrangement where a group of members pool their monthly contributions to pay for each other's private healthcare. It is not insurance — it's regulated under the Medical Schemes Act of 1998, overseen by the Council for Medical Schemes (CMS), and it has no shareholders. Any surplus stays in the members' reserve pool.
That regulatory structure is what makes medical aid in South Africa fundamentally different from products you might recognise overseas. A scheme cannot turn you down because of your age or health status. It cannot cancel your membership because you got sick. And it must, by law, cover a minimum set of conditions in full — what we call Prescribed Minimum Benefits, or PMBs.
Medical aid vs. health insurance vs. gap cover
These three sound similar but are governed by completely different laws. Here's how they actually differ:
| Product | Regulated under | How it pays | Typical use |
|---|---|---|---|
| Medical aid | Medical Schemes Act (CMS) | Pays providers based on actual cost, up to scheme rate | Primary cover for hospital and day-to-day care |
| Health insurance | Insurance Act (Prudential Authority) | Pays a fixed cash amount per defined event | Top-up for income protection or simple cash benefits |
| Gap cover | Insurance Act, capped by Demarcation Regulations | Pays the shortfall between specialist fees and scheme rate | Add-on alongside medical aid (max R215,712 p/p in 2026) |
Health insurance products cannot legally describe themselves as medical aid. If a product is not registered with the CMS, it is not medical aid — even if the marketing makes it sound similar.
How medical aid works
Every month, you pay a contribution. In exchange, the scheme funds your healthcare according to the rules of your chosen plan. There are four moving parts you need to understand:
- Hospital cover. Pays for planned and emergency admissions, including theatre, ward, and the doctors who treat you in hospital. On most plans this is "unlimited" up to a designated network of hospitals.
- Chronic medication. Pays for ongoing medication for registered chronic conditions. The 25 PMB chronic conditions are covered on every plan; comprehensive plans add many more.
- Day-to-day benefits. Pays for GP visits, acute medication, dentistry, optometry, and basic radiology and pathology. Funded either by a Medical Savings Account, a pooled benefit, or both.
- Preventive screening. Most plans now fund certain screenings (mammograms, prostate tests, flu vaccines, child wellness) outside of your day-to-day limits — these are listed in the brochure as "preventive care benefits".
The price you pay reflects how generous each of those four buckets is. A R1,800 hospital plan has bucket 1 only. A R12,000 comprehensive plan has all four with high limits and few network restrictions. The trick is matching the bucket sizes to how you and your family actually use healthcare.
The 6 major open schemes in 2026
An open scheme is one anyone can join, as opposed to a closed or restricted scheme that's tied to an employer or industry (like Polmed for police or GEMS for government). These are the six biggest open schemes by membership, with their 2026 contribution ranges pulled directly from official brochures:
| Scheme | Plans on offer | 2026 main-member range | Cheapest plan |
|---|---|---|---|
| Medihelp | 11 | R804 – R15 486/m | MedMove! Student |
| Fedhealth | 27 | R1 155 – R19 393/m | flexiFEDSavvy Hospital |
| Bonitas | 16 | R1 275 – R12 509/m | BonCore |
| Discovery Health | 25 | R1 350 – R11 430/m | Active Smart |
| Medshield | 10 | R1 821 – R9 489/m | MediCurve |
| Momentum | 6 | R2 029 – R16 469/m | Evolve Option |
Contributions shown are the 2026 main-member rate before late-joiner penalties or income-banded discounts. Adult dependants and child dependants are billed separately.
Plan types — with real 2026 examples
Every plan in South Africa fits broadly into one of four shapes. Here's what each looks like, with the three cheapest current examples from our dataset.
Hospital plans
The simplest, cheapest structure. Covers hospital admissions, PMB chronic medication, and emergencies — but not GP visits or pharmacy items. Suits younger, healthier members who use little day-to-day care.
Network plans
A hospital plan (or hospital + light savings) restricted to a specific list of hospitals and providers. The trade-off for the lower price is the co-payment if you use a non-network hospital — typically R8,000–R12,000 per admission.
Savings plans
Hospital cover plus a Medical Savings Account that funds your day-to-day care. Unused savings roll over to the next year. The middle ground in price and flexibility.
Comprehensive plans
Hospital + chronic + day-to-day + above-threshold benefits. Fewest restrictions, widest chronic cover, highest sub-limits — and the highest contribution. Suits older members, families with chronic conditions, or anyone wanting peace of mind.
Prescribed Minimum Benefits (PMBs)
PMBs are the legal floor of medical aid in South Africa. The Medical Schemes Act says every registered scheme, on every plan, must cover the diagnosis, treatment, and ongoing care of these conditions in full, with no annual limit, when treated at a Designated Service Provider.
There are three categories:
- 270+ medical conditions — defined diagnostic and treatment pairs covering most serious illnesses, from appendicitis to certain cancers.
- 25 chronic disease list (CDL) conditions — including diabetes (type 1 & 2), hypertension, asthma, epilepsy, HIV/AIDS, and major depression. Lifelong medication and monitoring must be covered.
- Any emergency medical condition — cover at any hospital, with no co-payment, regardless of whether it's in your network.
What this means in practice: a R1,500/month entry-level plan must, by law, give you exactly the same cover for a heart attack, cancer chemotherapy, or insulin as a R12,000/month top-tier plan — provided you use the scheme's nominated providers. The difference between plans isn't really the worst-case cover; it's the day-to-day flexibility, the network breadth, and the size of the day-to-day pot.
2026 price benchmarks
These are the actual numbers from our dataset of 95 plans, calculated live from current 2026 brochures. Use them to sanity-check any quote you've been given.
Cheapest plan in market
R804/m
Medihelp: MedMove! Student
Cheapest hospital plan
R1 155/m
Fedhealth: flexiFEDSavvy Hospital
Cheapest comprehensive
R7 945/m
Discovery Health: Classic Smart Comprehensive
Average single-member contribution
R4 810/m
Across all 95 plans
Median contribution
R3 797/m
Half of plans cost less, half cost more
Plans tracked
95
From 6 open schemes, all 2026
Adult and child dependant rates are additional. Some schemes (BonCap, KeyCare) use income-banded pricing where the rate scales with your gross monthly income.
How to choose a plan
Most people overpay because they buy on brand or on what their broker pushes. The right plan is whichever one matches the four variables below to your actual life.
1. Who needs cover?
Single, couple, family with kids, retired? Family size drives both the price and the relevance of features like maternity, paediatric dentistry, and child wellness benefits.
2. What can you sustainably afford?
Contributions go up around 8–12% every January. The plan you can afford this year needs to still be affordable in three years. As a rule of thumb, medical aid shouldn't push past about 10% of household take-home income. Compare family plans under R5,000 or single plans under R3,000.
3. Any chronic conditions or known needs?
If anyone is on chronic medication, planning a pregnancy, or expects elective surgery in the next year, check the formulary, the maternity benefit, and the in-network hospital list. Look at plans built for chronic cover.
4. Which hospitals do you actually want to use?
A network plan is only cheaper if your nearest preferred hospital is on the list. Check which schemes cover your local hospital before you commit.
Glossary of medical aid terms
Medical aid brochures are dense with jargon. Here are the 18 terms that matter most.
- Beneficiary
- Anyone covered by your medical aid plan — the main member, their spouse or partner, and any registered dependants.
- Co-payment
- An amount you pay out of pocket for a procedure or admission, in addition to what your scheme pays. Common on lower-cost plans for things like MRI scans or scopes.
- CMS (Council for Medical Schemes)
- The statutory body that regulates every registered medical scheme in South Africa. All schemes must hold a CMS registration number and submit annual financial returns.
- Designated Service Provider (DSP)
- A hospital, doctor, or pharmacy your scheme has contracted at an agreed rate. Using a DSP usually means no co-payment; using a non-DSP usually means you pay the difference.
- Day-to-day benefits
- Cover for things outside hospital — GP visits, acute medication, dentistry, optometry, basic radiology and pathology. Often funded by a savings account or pooled limit.
- Formulary
- The specific list of medicines your scheme will pay for in full. Medicines outside the formulary may be partly covered or attract a co-payment.
- Gap cover
- A separate insurance product (not a medical aid) that pays the difference between what specialists charge in hospital and what your scheme pays. Capped by law at R215,712 per person per year in 2026.
- Hospital network
- The specific list of hospitals your scheme will cover at full rate. Going outside the network usually means a co-payment of R8,000–R12,000 per admission.
- Late-joiner penalty
- A permanent surcharge added to your contribution if you join a medical scheme for the first time after age 35 without prior continuous cover. Up to 75% extra, depending on age.
- Medical Savings Account (MSA)
- A portion of your monthly contribution set aside in a personal pot for day-to-day expenses. Unused funds roll over each year and follow you if you change plans within the same scheme.
- Out-of-pocket
- Any healthcare cost you pay yourself, on top of your monthly contribution — co-payments, sub-limit overruns, non-formulary medicines, etc.
- Pre-authorisation
- Permission you must get from the scheme before a planned hospital admission, scan, or procedure. Without it, the scheme can refuse to pay or impose a penalty.
- Prescribed Minimum Benefits (PMBs)
- A legal minimum set of 270+ conditions, 25 chronic diseases, and emergency care that every registered medical scheme in South Africa must cover in full, regardless of plan.
- Self-payment gap
- On above-threshold plans, the period after your savings run out but before the scheme's day-to-day insurance kicks in. You pay these claims yourself.
- Sub-limit
- A cap inside a benefit — for example, an overall day-to-day limit of R20,000 might have a R3,500 sub-limit on optometry. Once you hit the sub-limit, you pay the rest.
- Threshold benefit
- Day-to-day cover that kicks in only after you've spent a set amount (the threshold). Common on comprehensive plans.
- Underwriting
- The process a scheme uses to assess your application. May result in a 3-month general waiting period or a 12-month condition-specific exclusion if you have pre-existing conditions and no prior cover.
- Waiting period
- A set time after joining during which you cannot claim for certain things. Maximum allowed by law: 3 months general, 12 months condition-specific.
Frequently asked questions
What is medical aid in South Africa?
Medical aid is a regulated, not-for-profit health funding arrangement where members pool monthly contributions to pay for private medical care. Every registered scheme is overseen by the Council for Medical Schemes and must cover a legal minimum set of conditions called Prescribed Minimum Benefits.
Is medical aid the same as health insurance?
No. Medical aid pays providers based on your actual medical costs and is regulated under the Medical Schemes Act. Health insurance pays a fixed amount per event (e.g. a flat R3,000 for a hospital admission) and falls under the Insurance Act. They are taxed and regulated very differently.
How much does medical aid cost in 2026?
Across the six major open schemes we track, the cheapest entry-level plan starts at R804/month for a single member, while top-tier comprehensive plans go up to around R19,400/month. The average single-member contribution across all 95 plans is around R4 810/month.
What are Prescribed Minimum Benefits?
PMBs are a legally required minimum set of cover that every medical scheme in South Africa must provide, on every plan, with no annual limit. They include 270+ medical conditions, 25 chronic diseases, and any emergency medical condition. Schemes must pay these in full at a Designated Service Provider.
What's the difference between a hospital plan and a comprehensive plan?
A hospital plan only pays for in-hospital treatment, PMB chronic medication, and emergencies — not for GP visits or pharmacy items. A comprehensive plan adds day-to-day benefits, more chronic conditions, and usually fewer hospital network restrictions. Hospital plans typically cost R1,200–R3,500/month for a single member; comprehensive plans R6,000–R12,000+.
Can I be turned down for medical aid?
No registered scheme can refuse to enrol you. They can, however, apply waiting periods (3 months general, 12 months condition-specific) and a late-joiner penalty if you're over 35 without prior continuous cover.
What is a late-joiner penalty?
If you join a medical scheme for the first time after age 35 with no proof of prior continuous medical aid membership, the scheme can permanently add a percentage to your contribution: 5%–75% depending on how long you went without cover. This applies for life, even if you change schemes.
Do I need gap cover as well?
Possibly. Specialists in private hospitals often charge 200%–500% of medical aid rates. Your scheme typically pays only 100%–300%. Gap cover (a separate insurance product) covers that shortfall, capped at R215,712 per person per year in 2026. It's most useful on hospital plans and lower-comprehensive tiers.
What happens if I use a hospital outside my network?
On network plans, going to an out-of-network hospital for a planned admission usually triggers a R8,000–R12,000 co-payment per admission. Emergencies are covered anywhere — schemes legally cannot impose a co-payment for genuine medical emergencies.
Can I change medical aid plans during the year?
Most schemes only allow plan changes once a year, during the November–December open enrolment period, with the new plan taking effect from 1 January. Changing schemes (rather than plans within a scheme) can be done at any time, but new waiting periods may apply.
What is a Medical Savings Account?
A Medical Savings Account (MSA) is a portion of your monthly contribution — typically 15%–25% — set aside in a personal pot to pay for day-to-day expenses like GP visits and acute medication. Unused funds roll over to the next year and stay yours if you change plans within the same scheme.
Are medical aid contributions tax-deductible?
You don't deduct contributions directly. SARS gives you a Medical Scheme Fees Tax Credit each month: R364 for the main member, R364 for the first dependant, and R246 per additional dependant in the 2026 tax year. Additional medical expenses above 7.5% of taxable income may also qualify.
Sources & methodology
Every contribution and benefit figure on this page is sourced directly from the official 2026 member brochure of the relevant scheme. We do not estimate prices. When a scheme publishes an update, we re-extract the data and the page updates automatically.
- Council for Medical Schemes (CMS) — medicalschemes.co.za
- 2026 member brochures from Bonitas, Discovery Health, Fedhealth, Medihelp, Medshield, and Momentum Health
- Medical Schemes Act 131 of 1998 and the Demarcation Regulations (2017)
- SARS Medical Scheme Fees Tax Credit table (2026 tax year)
Medical Aid Online is not a registered financial services provider and does not give financial advice. We are an independent comparison and education service.