Medical aid | MedicalAid.co.za

Your mid-year medical aid check-in: 5 things to review before your benefits run out

Posted on 8th June 2026

It’s June. If you’re like most South Africans on medical aid, you haven’t opened your scheme’s app since your first GP claim in February. Life moved on. Work got busy. The app stayed buried in a folder on your phone.

We are here to gently remind you that the halfway point of the year is actually the most useful time to check in on your medical aid, not because something is wrong, but because you still have time to fix it if it is. By November, when schemes open their annual review window, half your benefits may already be gone, and your preventive screenings still unused.

This isn’t a “should you switch” article. It’s a five-point check-in that takes less than an hour and could save you from some expensive surprises in the second half of 2026.

1. Check your medical savings account balance before it’s gone

Most medical aid plans place part of your monthly contribution into a Medical Savings Account, known as an MSA. This pool of money pays for day-to-day healthcare expenses such as GP visits, dentistry, optometry, and acute medication.

The MSA is separate from your risk benefits, which cover things like hospitalisation and certain chronic conditions. This distinction matters because your MSA can run dry, and when it does, you pay out of pocket for every GP visit and prescription until January.

If you’ve had a couple of illnesses, dental work, or a family member that visits the doctor regularly, there’s a real chance your MSA is already running low by June.

What should you do?

Log into your scheme’s app or member portal and look for your “savings balance” or “day-to-day benefits remaining.” Most major schemes display this clearly on the dashboard. If yours doesn’t, call the member helpline and ask for your current savings balance and year-to-date claims.

Pay attention to what remains halfway through the year. If your MSA balance sits below 30% or 40% by June, you’re moving toward depletion before December. Knowing this now changes how you plan the rest of the year.

2. See how much of your annual benefits you’ve actually used

Beyond your MSA, most plans include annual limits for specific benefit categories. These work differently from your savings: they don’t run dry in the same way, but once you’ve hit the limit for the year, claims in that category stop paying out.

The categories to check:

GP consultations – some plans limit the number of visits or the total rand value covered per year for GP consultations.
Acute medication – this usually comes from savings, but some plans apply separate limits.
Dental – most plans have an annual dental benefit, separate from savings.
Optical – typically a biannual benefit with a fixed amount for frames, lenses, and eye tests.
Radiology and pathology – X-rays, blood tests, and scans often draw from both savings and risk benefits depending on the plan.

Pull up your year-to-date claims statement through your member portal and run through each category. The question isn’t whether you’ve used a lot, it’s whether you’re pacing correctly for the rest of the year.

If you’ve used 70% of your dental benefits by June, you know to space out any non-urgent dental work. If you’ve barely touched your optical benefit and need new glasses, now is the time, not in November when everyone else has the same idea.

While reviewing your statement, look for rejected claims. Many people ignore them after the first rejection notice arrives. Yet some claims fail because of missing codes, missing documents, or submission errors. A rejected claim from April still deserves attention in June.

3. Book those preventive screenings before Q4 gets busy

This is the one most people forget, and it’s the most straightforward item on this list.

Most medical aid plans in South Africa cover a range of annual preventive screenings at no cost to you from the risk pool. That means these screenings don’t touch your MSA. They’re a genuine benefit you’re entitled to, and most members either don’t know about them or keep meaning to book them.

Depending on your scheme and plan, covered screenings typically include:

Blood glucose (diabetes screening)
Cholesterol and blood pressure checks
Pap smears (annual for women)
Mammograms (frequency varies by age)
Prostate-specific antigen (PSA) tests for men from a certain age
BMI and general wellness assessments

The reason to book them now is all about availability. GP practices and wellness clinics are genuinely busier in Q4. They are busier because people are rushing to use benefits before year-end, or due to seasonal illness, and appointment slots are becoming scarce. Booking in June or July means you get the time slot you want.

Check your scheme’s benefit schedule or call your GP to confirm which screenings are covered under your specific plan. Then book. It takes ten minutes and you won’t have to think about it again.

4. Make sure your dependants are still correctly registered

Dependant details seem like admin, and they are, until you need to claim on behalf of someone whose information is out of date.

The common situations that cause problems:

A child turning 21 – most schemes remove child dependants at 21 unless they’re registered as full-time students or meet specific criteria. If your child turned 21 this year and is still studying, you may need to submit a student affidavit to keep their cover active.
A new baby – newborn registration creates another risk. Most schemes require babies to be added within a specific period after birth. Miss the deadline and waiting periods enter the conversation.
Marriage or divorce – adding a spouse or removing an ex-spouse requires formal scheme notification, usually with supporting documentation.
A dependant who passed away – removing a deceased dependant matters for premium calculations going forward.

When a claim is submitted for an incorrectly registered dependant, the scheme can reject it. You can appeal, but that takes time. The fix is simpler before the claim happens.

Log into your member portal, check the list of registered dependants, and confirm the information is current. If anything needs updating, contact your scheme’s member services directly.

5. Ask yourself: does this plan still fit your life?

This isn’t the same question as “should I switch medical aids?” It’s a more honest question about whether the plan you chose in January, or two years ago, still matches what your family needs.

Three questions worth sitting with

Is your MSA running out faster than expected? If you’re consistently depleted by mid-year, your plan’s savings allocation may be too low for your household’s actual usage. A plan with a larger savings component might serve you better.

Are you paying for benefits you’re not using? If you’re on a comprehensive plan and your family hasn’t had a single in-hospital event in years, you might be over-insured for what you’re actually using.

Has your family structure changed? A new baby, an ageing parent added as a dependant, or a child leaving the plan, all these changes what your plan needs to do.

This is where MedicalAid.co.za’s comparison tool earns its place. Enter your age, income, and family size, and compare plans side-by-side without committing to anything. It’s free, takes a few minutes, and gives you a clear picture of what else is available before the formal annual review period opens later in the year.

Doing this in June means you have time to think it through properly, rather than making a rushed call in November.

DSPs explained: why going out of network can cost you more

Posted on 25th May 2026

“My plan is active, so why did I still pay?” is not a new question to South Africans. You pay your medical aid every month… so why does a bill still land in your inbox?

If you have ever asked that after a doctor visit, scan, or hospital visit, you’re not alone. Many South African medical schemes use provider networks to manage costs and agree on rates. That’s where Designated Service Providers (DSPs) come in.

This guide explains how DSP and network rules typically work, when extra costs may apply if you go out of network, and what to check before you claim.

In most situations, “out of network” doesn’t mean your claim will automatically be rejected. Instead, different rules may apply. For example, there could be a co-payment, a payment limited to the scheme rate, or additional steps like pre-authorisation.

You’ll also find a simple checklist to use when comparing options. That way, you can spot network rules that may matter most to you or your household.

View options to compare the benefits of different medical aids side-by-side before you choose.

What is a DSP in South African medical schemes?

A Designated Service provider (DSP) is a healthcare provider, or group of providers, that has a contract with a medical scheme and is listed in the scheme rules as a preferred provider for certain services.

Your option may guide you toward certain hospitals, doctors, pharmacies, or service providers for services like scans or blood tests. Importantly, whether a provider is “in network” may depend on the specific service you need, not only the provider itself.

DSP vs network provider

You may notice that “DSP” and “network provider” are often used interchangeably in member communication. Some schemes use “network” as the easier term, while “DSP” usually appears in official benefit documents and option rules.

Either way, the practical point remains the same: If your option lists preferred providers for a service, using someone outside that list may change how the claim is paid.

What does “out of network” mean in practice?

When people hear “out of network”, they often think of hospitals first. But network rules can apply to many types of healthcare services.

Depending on your option, this may include:

GPs and specialists
Pharmacies (including repeat medicine)
Pathology and radiology (blood tests, MRI, CT)
Referral pathways and authorisation steps

Because networks differ by scheme and option, two people can be on the same scheme and still have different network rules.

Why schemes use networks

Networks help schemes agree on rates and billing processes with specific providers. They also support more predictable care pathways for certain services. Many options use tools like pre-authorisation, protocols, and formularies to guide how care is accessed and paid, especially where costs can escalate quickly.

How going out of network can cost you more

3 common cost outcomes

Going outside your option’s network doesn’t always mean a claim won’t be paid. However, different cost outcomes may apply depending on the scheme rules. Some of these outcomes include the fact that:

1) Co-payments may apply

If your option rules require a DSP or network provider for a service, choosing a non-network provider may trigger a co-payment.

Example: Your option requires a network radiology group for MRI scans. If you book at a non-network practice, a co-payment may be charged, depending on your rules.

2) The scheme pays up to a set rate, and you pay the difference

Many services are reimbursed at a scheme rate (scheme tariff). If a provider charges above that rate, you pay the balance.

Example: A specialist charges above scheme rate. Your scheme pays up to the allowed rate on your option, and the difference may be for your own account. This is sometimes called balance billing.

3) A claim may be reduced if rules aren’t followed

Some options require certain steps before treatment takes place. If these steps aren’t followed, benefits may be affected.

Example: A planned hospital admission may require pre-authorisation. If authorisation isn’t obtained, the claim may be reduced, or a co-payment may apply depending on the rules.

These outcomes aren’t automatic. The exact detail always depends on the scheme rules. But knowing the common triggers beforehand can help you avoid unexpected costs.

View options to see how different options handle network rules, scheme rates, and common co-payment triggers.

Where people get caught out most often

If you’re new to medical schemes, it helps to know that network rules usually appear in everyday healthcare moments, not only during major events. These are situations where members are often surprised by extra costs. Some of these situations include:

Planned scans and diagnostics

MRI scans, CT scans, specialised blood tests, and radiology services are often linked to preferred provider networks. If you use a provider outside the network, the claim may be paid differently.

Specialist visits

Specialists sometimes charge above scheme rate. In addition, some options require referrals or specific pathways before specialist consultations are covered fully.

Hospital admissions

Hospital networks can be strict. Your option may only include certain hospital groups or apply different rules if you choose a non-network hospital for planned procedures.

Medicine and pharmacy choice

Some options require members to use preferred pharmacies or follow a medicine formulary. If scripts are filled outside those rules, benefits may be paid differently.

So, the simplest way to avoid surprises? Check the rule before you book, not after the claim is processed.

Quick checklist: what to check before you book a procedure or get admitted.

Before committing to a provider or procedure, it helps to run through a few key questions:

Is this provider in-network for my option and for this service?
Do I need pre-authorisation?
Do I need a referral to see a specialist?
Are there protocol or formulary requirements for this service or condition?
What co-payments are listed in the option rules for out of network use?
What rate does the scheme pay for this service, and what may be for my account if the provider charges above that rate?

How to compare options on Medicalaid.co.za

When comparing medical aid options, it helps to look beyond the premium. Instead, focus on how each option handles network rules and claims processes.

Here are five things worth comparing:

Network and DSP requirements (hospital, pharmacy, day-to-day providers).
Authorisation and referral rules (what needs approval and when).
Co-payment triggers (especially out-of-network rules).
Scheme rates and how provider charges are handled.
How clearly the option explains benefits and member responsibilities.

If you’d like to understand these topics in more detail, explore the explainers on the Medicalaid.co.za news page. They cover some of the most common medical aid questions South Africans ask.

View options as the next step for early-stage research, so you can compare medical aids side by side before choosing the one that is best for you.

Medical aid for young professionals: What to compare before you join

Posted on 24th April 2026

Starting your career means earning your own income. It also means managing real financial responsibilities. Medical aid is one of the biggest monthly commitments you will make, so choosing blindly isn’t an option as the wrong medical aid choice can unnecessarily cost you thousands over time.

Many young professionals focus on one thing only. Price. However, the cheapest plan is not always the smartest move.

Before joining a scheme, here are seven key considerations every young professional in South Africa should compare carefully.

If you are already exploring options, it helps to compare medical aid options online. You can view plans side-by side and see how they differ based on your budget and health needs here. Why guess when you can compare easily in one place for free? So, what should you be comparing exactly?

1. Monthly contribution vs financial risk

First, weigh up what you pay each month versus the health needs you have. Hospital plans usually have lower monthly contributions. However, day-to-day expenses like GP visits are paid directly out of your pocket.

Comprehensive plans cost more monthly. In return, more day-to-day benefits are covered.

The real decision is simple. Do you prefer lower monthly costs with higher out-of-pocket risk? Or higher monthly costs with fewer financial surprises later? Understanding this trade-off is essential when choosing a medical aid in South Africa.

2. Hospital networks and restrictions

Not all hospital benefits are the same. In fact, they can differ more than you think. Many schemes, including Discovery, Bonitas, Momentum and Medihelp, use network hospitals or Designated Service Providers (DSPs) on certain options.

This may mean:

Access to specific private hospitals only.
Co-payments, often around 30 percent, if you use a non-network hospital.
Pre-authorisation requirements before admission.

If you live in a major metro, network plans can work well because several hospitals may be available nearby. In smaller towns, network limitations can be more restrictive.

Therefore, always check which hospitals are included on your specific option. Assumptions often lead to unexpected costs.

3. Medical Savings Account structure

Next, understand how the Medical Savings Account works.

Some plans have no savings component. Others allocate a portion of your annual contribution, often between 10 and 25 percent, into a Medical Savings Account.

It’s important to distinguish between:

Medical Savings Account – the member-funded portion.
Insured benefits – paid from the scheme’s risk pool.
Out-of-pocket expenses – paid directly by you.

On many options, GP visits, dentistry and basic tests are paid from savings first. Once savings are depleted, you pay out of pocket unless the plan includes additional insured day-to-day benefits.

This structure plays a major role in how much financial flexibility you actually have during the year.

4. Chronic benefits (even if you are healthy)

You may feel young and healthy today. But there’s so much more to consider. Many young professionals manage long-term conditions such as:

Asthma
Depression
Hypertension
Long-term contraception

Medical schemes must provide PMBs, including the Chronic Disease List, in line with the Medical Schemes Act 131 of 1998.

However, PMBs are subject to:

Registration requirements
Approved formularies
DSP rules

This means medication is not automatically paid unless you follow the correct process. So, do you know how chronic benefits work on the option you are considering? Would you need to register a condition? What happens if you do not? These details matter more than you think.

5. Co-payments and shortfalls

This is one of the most overlooked factors. And yet, it causes the most frustration. Examples include:

MRI and CT scan co-payments.
Specialist accounts charged above 100 percent of scheme rate.
Penalties for not obtaining pre-authorisation.

When a plan says it pays “100% of the scheme rate”, it does not always mean the full bill is covered. Some specialists charge above scheme rates. The difference becomes your responsibility.

So, ask yourself: If a specialist charges more than the scheme rate, can I cover the shortfall?

Understanding this builds realistic expectations. It also prevents nasty surprises later.

6. Waiting periods

If you are joining a medical aid for the first time, or moving from medical insurance to a medical aid, underwriting rules may apply.

These can include:

A 3-month general waiting periods
Or a 12-month condition-specific waiting periods

Waiting periods are regulated under the Medical Schemes Act and applied according to scheme rules. So, here is the key question: If you needed treatment next month, would it be covered? Always confirm how waiting periods may affect you before joining.

7. Ability to upgrade later

Right now, your budget might be tight. That is normal at the start of your career. However, your income is likely to grow over time.

So, before choosing the cheapest medical aid for young people, check:

If the scheme allows internal option upgrades where waiting periods may not apply.
When upgrades can take place.
How contribution increases are structured.

Flexibility matters just as much as affordability.

Quick comparison framework

Here is a simple way to compare:

This framework helps you compare medical aid for young adults in South Africa more objectively.

So, how do you choose the right medical aid as a young professional?

As a young professional, your goal is not to find the “best” medical aid. That does not exist. Your goal is to find the right balance between affordability and financial protection.

So, what matters more to you right now? Lower monthly costs or fewer financial surprises down the line?

Use our comparison tool and get side-by-side prices and benefits based on:

Your monthly income
Hospital access preferences
Chronic needs
Savings structure

View your options today. Because the best time to protect your health and your finances is before you need to.

5 Smart Medical Aid Tasks to Start the Year Right

Posted on 21st January 2026

5 Smart medical aid tasks to do in January

Still recovering from festive spending? Your healthcare costs shouldn’t be the next surprise. For South Africans on medical aid, January is the most valuable time to lock in smart healthcare moves.

Think of it like a reset button for your healthcare. Get ahead now, and you’ll avoid unnecessary payments, claim rejections, and late-year panic.

Here are five simple but powerful tasks you can do this month to make sure your medical aid works for you.

1) Set up your preventive screenings early

Most medical aid schemes in South Africa cover essential preventive health screenings at no cost to you. These include:

Pap smears
Mammograms
Prostate exams
Cholesterol checks
Glucose tests

These medical aid benefits are often paid from your risk portion, not your savings, meaning they don’t reduce your available day-to-day funds.

January is the best time to book them. Not only are healthcare providers typically less busy, but it’s also easier to secure appointments that fit your schedule. Booking early also reduces the chance of forgetting about them altogether.

Some schemes, like Discovery’s Personal Health Fund, reward members for staying proactive about their health. When you complete your annual health checks, you can unlock funds in your Personal Health Fund to use for everyday medical needs – including physio, mental health support or other out-of-hospital expenses. Many other medical schemes offer similar incentives for preventive care, encouraging members to act early rather than waiting until something goes wrong.

2) Check your savings and day-to-day medical aid benefits upfront

One of the easiest ways to lose money on medical aid is to misunderstand how your plan splits benefit between risk and savings.

Start by logging into your medical aid app or online portal. A healthcare broker can also help you with your needs analysis.

Take note of your:

Available medical savings balance
Annual day-to-day benefit limits
What services are covered under “risk” (typically includes screenings, chronic medication, immunisations)

For example, children’s vaccinations and dental checkups are usually paid from risk. But if you don’t claim them correctly or if the provider isn’t coded correctly, you could unintentionally use up your savings early in the year.

A few minutes now can help you avoid using your entire savings allocation before March.

3) Download your scheme’s app and activate digital authorisations

Medical aid apps are more than just balance checkers. They help you manage your medical aid benefits in real time.

If you haven’t already, download your scheme’s app and explore features like:

Digital pre-authorisations for hospital visits or specialist consultations
Claim submissions via photos or digital uploads
Provider search tools to find network-approved doctors or hospitals
Real-time benefit tracking

This isn’t just about convenience. If you can submit claims and authorisations quickly, you reduce the risk of delays or admin errors that lead to out-of-pocket payments. Plus, getting to grips with the app now means you’re ready when a real medical need arises later.

4) Make sure dependents still meet eligibility rules

Many members get caught out by dependent eligibility changes, especially after December, when children turn 21 or return to university.

Most medical aid schemes require updated documents for adult dependents. If your child is over 21 but still studying, you’ll likely need to submit a proof of registration or similar documentation. If that’s not done, they may be removed or reclassified as adult members, which often means:

Higher monthly premiums
Claims being rejected unexpectedly

Also, check whether new dependents (like a baby born in December) have been added and approved. Don’t assume the paperwork is automatic.

5) Review your DSPs for medication and planned procedures

Designated Service Providers (DSPs) are a critical part of managing your medical aid costs. Every scheme has a network of preferred:

Pharmacies
Hospitals
Medical specialists
Dentists
General Practitioners (GP)

If you use a provider outside your scheme’s Designated Service Provider (DSP) network, especially for chronic medication or planned procedures, you could face steep co-payments. Gap cover can help you with these types of co-payments

In January, go through your scheme’s updated 2026 DSP list. Make sure your:

GP is still in-network
Pharmacy is listed for chronic meds
Hospital choice for planned procedures is covered

If you need to switch providers, better to do it now before you need treatment.

For example, getting chronic medication from a pharmacy not on your network, can lead to an on average 30% co-payment (be sure to confirm with your broker and your scheme what sort of co-payment applies to your specific option. That’s a costly mistake that’s easy to avoid with a quick check.

Final Tip: One hour now can save you thousands later

Medical aid in South Africa is complex, but it’s not beyond your control. Spending just an hour in January reviewing your medical aid benefits, checking balances, and updating documents can save you thousands in avoidable expenses later in the year.

Think of it like setting up debit orders or doing your tax prep. It’s admin that pays off.

Already locked into your 2026 plan? No problem. You can still use MedicalAid.co.za to compare medical aid benefits, understand how your plan stacks up, and prepare better questions for your broker or scheme. It’s a smart way to stay informed, so your medical aid works for you all year.

What to do if you need emergency care over the festive season

Posted on 8th December 2025

Each year, medical schemes review their benefits and contributions. These updates shape how much members pay, and what they receive in return, so taking a moment to understand what’s changing in 2026 can help you make smarter health cover decisions.

The festive season is known as the ‘period of celebration’ that takes place during December and some of January. For many South Africans it’s also the time to slow things down and spend quality time with family and friends, while enjoying a lekker braai.

Although there are much laughter and joy, it’s also a period where the rate of medical emergencies and accidents increase. Many of us don’t know what to do or who to call if an emergency arises. This blog provides you with important steps you can take if an emergency comes your way.

Common emergencies

Hospitals see more of these during December and January:

Drowning
Road accidents
Holiday decorating injuries
Food poisoning
Kitchen-related injuries
Slips and falls
Heatstroke

Being prepared matters. Acting correctly matters more.

Step 1: Stay calm and assess

Panic worsens emergencies, so it’s important to breathe. Check for danger. Do not move someone injured unless they are in immediate danger. Rather call emergency services for help. If you are bitten by a snake, try to take a photo of the snake so emergency services can identify if it is venomous and how to proceed.

Step 2: Call the right number

South Africa has multiple emergency lines:

112 from any cell phone connects to all services
10177 is the national ambulance number
Netcare 911: 082 911 (Private)
ER24: 084 124 (Private)

Private services work with most medical aids. Check your policy schedule to see what ambulance you can use. Emergency services can guide you, dispatch ambulances, and manage hospital transfers.

Step 3: Pre-Authorisation

In the event of an emergency (ER Visit) the hospital will contact your medical aid for pre-authorisation. The medical aid will then send authorisation straight to the hospital. Remember you will also need to get pre-authorisation if you are admitted into hospital.

Quick tip: Ask if your medical aid has given authorisation for procedures before entering the Operating room, if not how much are they willing to pay. That is where gap cover will step in.

Step 4: Know what counts as a medical emergency

Emergencies include sudden life-threatening conditions that will cause loss of life, serious impairment of bodily function, serious and lasting damage to organs, limbs, or other body parts. These are known as Emergency Prescribed Minimum Benefit’s (PMBs).

Examples:

Uncontrolled bleeding
Breathing difficulties
Fit or epileptic seizure
Broken arms
Heart attack
A stroke

If your case does not meet these criteria, it may not qualify. Ask your provider for clarity.

Step 5: Go to a network hospital

Medical aids cover specific hospitals. Non-network hospitals may result in co-payments or full charges. In the event of an emergency and there is no network hospital within 40km then any hospital will be accepted.

Here are some tips on accessing your network:

Save your network hospitals on your phone
Check for hospitals near your holiday destination that are in your network
Be prepared to tell paramedics your scheme and plan type

Step 6: Keep your details ready

Time is critical. Keep these on hand:

Membership card or digital copy.
Plan type and number
Emergency contact
List of chronic conditions and current medication
ID copy

Store the details on your phone through your health ID and carry a hard copy in your car or bag.

Step 7: If you travel abroad

Most South African medical aids have limited cover international emergencies.

Ask your scheme about travel benefits and how much the maximum amount is
Consider travel insurance that covers medical emergencies

A small premium can prevent large bills.

Be prepared

The festive season should not leave you with debt or risk. Not all plans cover transport to hospitals, nor do they offer cover for all hospitals. It’s a good time to take a closer look at your benefits and potentially compare different medical aids in South Africa with MedicalAid.co.za. Ensure your plan covers emergencies, travel, and network hospitals.

Emergencies can happen at any time. During the festive season, services are stretched. Being informed is your protection. Save numbers. Know your cover. Know your nearest hospitals. Have your details ready. Help is only a call away. Will you take steps now to secure care for yourself and your family?

2026 Medical scheme benefit and premium update hub

Posted on 13th November 2025

While increases still need regulatory approval, here’s a snapshot of confirmed updates and new benefits from South Africa’s leading medical schemes.

Bestmed

Bestmed has introduced an average benefit increase of 4.6% across all plans, along with several meaningful enhancements:

Preventative care: Faecal occult colon cancer screening is now available every 24 months for members over 40.
Surgical cover: Adenoidectomy for both adults and children has been added to the Rhythm 1 option, combined with tonsillectomy benefits.
Hearing devices: Cochlear implant and BAHA limits have been raised, up to R350,000 on Pace 4.
Breast reduction: Pace 3 and 4 now include a medically necessary breast reduction benefit, capped at R100,000.
Take-home medicine: Allowances for chronic and retail pharmacy take-home medication have been increased by at least 175%, now ranging from R450–R700.
Contraceptives: Female contraceptive benefits have been split into two clear limits: oral contraceptives (R2,092–R2,801) and IUDs (R3,295–R4,225).

Discovery Health

Discovery’s contribution increases will only apply from 1 April 2026, giving members a few extra months at current rates.

The Smart Saver range, launching 1 January 2026, brings a new combination of value and flexibility, including:

Up to 200% hospital cover on the Smart network.
A built-in Medical Savings Account.
A Personal Health Fund.
Unlimited Smart GP visits.
Dental, optical, and over-the-counter benefits.

Bonitas

Bonitas is focusing on younger members with its new BonCore plan, designed for individuals and couples aged 22–35. Benefits include:

Unlimited network hospital cover.
Unlimited virtual GP visits and 3 in-person consultations.
Cover for 28 chronic conditions.
A R1,000 Benefit Booster.
Preventative screenings.

The Primary Select plan has evolved into BonPrime, a savings plan with 16% allocated to savings, giving members more control over everyday costs.

Medihelp

Medihelp has two refreshed options stand out for 2026:

MedVital: Improved overall value across key benefits.
MedReach (previously MedElect): Now tailored for professionals seeking convenience and quality. Includes unlimited hospital cover, day-to-day benefits, and extended radiology, dental, and eye care coverage. The MedElect Student option has been discontinued.

Medshield

Medshield has a strong focus on screening and chronic care improvements this year:

AI Optical Diabetic Screening across all options except MediPhila and MediCurve.
Reduced chronic medicine co-payments on most plans.
Annual mammograms for women 30+ (previously every two years).
Dis-Chem has been added as a Designated Service Provider (DSP) for chronic medication.

Momentum Health

Momentum has introduced several preventive and accessibility upgrades:

FIT (Faecal Immunochemical Test): Now available annually for members aged 45–80 on all options except Ingwe.
Ingwe income brackets increased by 4.5% to make coverage more accessible.
Student/child principal rate: R645 per month.
Maternity benefit: Online antenatal and postnatal classes now hosted by ParentSense.
Dental cover: Preventative benefit raised to R500 per beneficiary.
Average co-payment increases of 4%.

Fedhealth

Fedhealth continues to expand coverage for women’s and mental health, as well as preventative care for seniors:

FlexiFED 1: Expanded maternity benefits, including more scans, consultations, and antenatal classes.
Mental health: Depression medication now covered even on entry-level plans.
Emergency contraception is now covered across all options.
Senior care: Pneumococcal vaccine added for members 65+.
Oncology: 25% higher brachytherapy limits on FlexiFED 4.
Day-to-Day Plus (D2D+): Rewards members who complete a health risk assessment and join Sanlam Health Rewards, unlocking up to R4,500 for additional day-to-day cover.

Compare your cover for 2026

Our updated comparison tool on MedicalAid.co.za now reflects 2026 benefits and contributions across all major schemes. It’s designed to help you see what’s changing, and decide whether your current plan still meets your needs.

Start the new year with confidence. Compare your cover and see exactly what you’ll be getting in 2026.

Making sense of your medical aid review period

Posted on 21st October 2025

Just like every other year, in 2026, medical aid members all over South Africa will receive an updated set of benefits. Nearly all of these packs contain small, intricate changes that affect both your health and your wallet. Their fine print might be difficult to navigate, but here is some good news; understanding your review period for your medical aid does not have to be difficult. With the correct information, instead of making it stressful, this review period can be used to ensure that you are still receiving the best value for your money.

Why the review period matters

Think of the review period as your annual financial health check. It’s the moment when your medical aid scheme lays out what’s changing for the year ahead. Some changes will have little impact, while others could affect your household budget or even the doctor, you’re able to see.

Premium increases

The first thing most people notice is the higher monthly premium – a rise that’s almost inevitable, irrespective of any pay increase for the main member on the horizon.

Take this example: R200 a month may feel small, but over a year that’s R2,400. The real question is – does this extra cost add value to your future, or just drain your budget?

Benefit adjustments

Not all changes are bad news. Sometimes benefits improve, like more GP visits or higher allowances for specialist scans. Conversely, sometimes cover shrinks. Because of this, you’ll lose cover sooner and tiny changes end up accumulating. This is why you need to ensure that your plan suits your lifestyle and daily activities.

Provider network changes

This is one area where people often get caught off guard. You could find that your chosen clinic or MSP hospital is no longer in your plan’s network. When this happens, you might need to pay additional charges or change providers. Being informed of this enables you to prioritise what matters to you more, either continuing with your doctor or minimising expenses.

Out-of-pocket increases

Additional co-payments, new exclusions, or increased deductibles are all examples of concealed charges that can accumulate quietly over time. The problem is that you typically become aware of them during an emergency, when you do not expect to receive an additional bill. Fine-tuning your policy now can prevent those unpleasant surprises in the future.

Value-adds

Medical aid schemes love to talk about their “extras”: wellness apps, rewards programmes, or free preventative screenings. Some of these are genuinely useful, especially if they help you stay healthier for longer. Others might simply inflate your premiums without offering much day-to-day benefit. The key is to ask: Will I really use this?

Time to reassess

Your 2026 benefit pack isn’t just paperwork: it’s a signal to pause and check if your medical aid plan still matches your lifestyle, health needs, and budget.

Don’t just accept the changes in your 2026 benefit pack. Compare your plan today with MedicalAid.co.za and find the option that truly fits your health and budget needs.

What the medical aid review period means for you (and why it starts before November)

Posted on 18th September 2025

Every year around this time, something big happens in the world of medical aid, and it’s not just in November.

If you currently hold medical cover under an open medical aid scheme or are thinking of subscribing to one, the time between September and December is your months of opportunity. This is when medical scheme administrators begin updating existing schemes upwards in premiums, tweaking benefits, changing provider networks, and changing cover limits, all meant to be effective from the following January.

The knowledge of the annual review schedule stands to benefit your decision-making when determining health cover for 2026. Here follows some information for you to know.

What is the medical aid review period (and when does it start)?

The medical aid review period generally runs from late September through to December, although exact dates vary between schemes. Most of the major schemes begin releasing information in late September or early October, first to brokers and then to the public.

During this time, you’ll start seeing:

Premium (monthly contribution) changes
Updated benefit limits
Network provider adjustments
Revised co-payments or exclusions
New wellness tools or added-value services

While many refer to it as the “November review period,” the process typically kicks off from September, with more schemes revealing their updates as the weeks progress.

Why do these changes matter?

Your medical aid plan is not static and neither are your healthcare needs. Schemes revise their options annually to:

Keep pace with medical inflation and provider fee increases
Align with updated industry regulations
Adjust for changes in member claims and utilisation patterns
Introduce new digital tools or services for better member support

Staying informed about these updates is essential. A plan that served you well this year might not suit your needs or budget in 2026.

What to look out for during review season

When your scheme’s updates become available, pay close attention to:

Premium increases: What’s your new monthly cost?
Benefit adjustments: Are limits going up or down?
Provider network changes: Will your current doctor or hospital still be covered?
Out-of-pocket increases: Are there new co-payments or exclusions?
Value-adds: Are there any new wellness tools, apps or rewards?

Doing a medical aid comparison helps you weigh up your current plan against what’s newly available across different schemes and options, without necessarily switching funds.

Should you switch funds or just change options?

In most cases, switching to a different option within your current fund is the safer, easier route, especially if your needs have changed. Switching to a different scheme entirely can trigger new waiting periods or exclusions for certain conditions.

Unless there is a compelling reason, it’s usually better to stay within your existing medical aid and look at more suitable options under that umbrella.

How MedicalAid.co.za can help

With dozens of schemes and hundreds of options available in South Africa, comparing medical aids can quickly become overwhelming. That’s where MedicalAid.co.za comes in.

We track benefit updates and provide easy-to-understand comparisons, so you can see what fits your needs best, all in one place. Just note: not all premiums and benefits are available at once. Our updates are added as schemes release them, so check back often or speak to one of our consultants for real-time advice.

How to Prepare for the Review Period

Here are 4 simple steps:

Review your current plan: Know what you are paying for, and which benefits you primarily use.
Assess your healthcare needs: What has changed this year? Are there new diagnoses, dependants, or budget changes?
Stay informed: Watch for communication from your scheme and follow any pertinent updates posted on MedicalAid.co.za.
Get expert guidance: Consult a specialist if you need clarification. An informed decision today saves frustration (and bills) later.

In conclusion

Updates aside, whether that will happen in September or October, being proactive is what truly matters. This review period presents the perfect opportunity to reassess, realign, and ensure that your medical aid covers your needs. In view of this, with such foresight and by utilising the right tools, you should be able to step into 2026 with a plan that fits just perfectly.

The Power of Prevention: How Women Can Take Full Advantage of Their Preventative Care Benefits

Posted on 18th August 2025

When it comes to women’s health, prevention is much more than peace of mind. It is a proactive measure to live well and stay well. Too often the benefits of preventive care are overlooked simply because we do not know that they exist.

But did you know that depending on your South African medical aid, you could have free or subsidised screenings, contraceptives and even maternity wellness services?

So how does preventative healthcare actually benefit you and how can you ensure that you are not missing out on benefits that your medical aid already pays for?

What preventative care is included in many medical aid plans

Preventative care benefits vary from plan to plan, but many South African medical aids include a core of free or subsidised services, either as part of Prescribed Minimum Benefits (PMBs) or specific scheme benefits.

These often include:

Annual PAP smears and mammograms (especially for women 40+)
HIV, cholesterol, and blood sugar screenings
Contraceptive cover — such as oral contraceptives, injectables, or IUDs
Childhood immunisations
Antenatal and postnatal care
Wellness screenings through pharmacies or scheme partners

While the exact details depend on your plan, most offer these preventative care services either from your risk benefit (not affecting your day-to-day savings) or as added value services. That means they often cost you nothing extra, you just need to use them.

Why using preventative benefits saves you more in the long run

These are carried out to help in the prevention of avoidable complications, which could be debilitating and costly. A routine PAP smear could catch the early signs of cervical cancer, and yearly breast exams may be able to detect abnormalities before they require invasive treatment. Likewise, checking blood pressure or glucose regularly is the best way to prevent future and far more severe complications such as stroke or diabetes.

By using these benefits early and consistently, you reduce your risk of:

Unexpected hospitalisations
Costly treatments down the line
Co-payments for avoidable chronic conditions

In other words, putting your health first today means fewer financial and emotional concerns tomorrow. It’s not merely about staying well; it’s about staying financially protected.

Maternity and contraception: What’s often included (and what’s not)

Preventative care becomes more pertinent if planning to have a baby or already expecting. Numerous medical funds offer separate maternity and contraceptive benefits designed to assist and accommodate you in every phase of your journey.

These may include:

Antenatal consultations (up to 6–12 visits)
Ultrasounds and blood tests
Newborn screenings
Access to 24/7 baby advice lines (like Bonitas’ Babyline)
Lactation consultants or milestone check-ups
Monthly allowances for antenatal supplements (e.g., R195/month for vitamins)
Contraceptive benefits, including hormonal options, implants, or IUDs

However, not all plans are created equal. Some cover these from the hospital benefit only, while others include dedicated maternity programmes, even on entry-level hospital plans. Always check the fine print.

How to find out what your plan includes

Understanding your preventative healthcare benefits starts with knowing where to look. Here’s how to make sure you’re in the know:

Log in to your member portal to view your benefits and remaining limits
Download the scheme’s benefit guide or brochure
Check if services are paid from your savings or the risk pool
Confirm which provider networks are covered
Ask if pre-authorisation is required for screenings or maternity care

If in doubt, speak directly to your medical aid or a broker who can walk you through your cover. Being informed means being empowered, especially when it comes to your health.

Prevention is powerful, and often already paid for

Your medical aid isn’t just a safety net – it’s a gateway to smarter, healthier living. Preventative care covers a wide range of benefits, including contraceptives, cancer screenings, and maternity support. Every woman’s health journey is unique and ever-changing – make sure you’re making the most of the benefits designed specifically for you.

So, next time you procrastinate when booking that check-up, or when reminders keep ringing for your respective screening, remember that prevention is not an option but a right.

Compare schemes now with MedicalAid.co.za to find a plan that puts your health first. Let’s help you make the most of your preventative healthcare benefits, because your wellbeing is worth it.

How to Maximise Your Medical Aid Benefits in 2025

Posted on 13th January 2025

With January, we welcome a time to take stock of your healthcare cover and try and get the best out of your medical aid scheme. Whether you are new to medical aid or simply seeking relief from the limitations of your current plan, understanding what your plan is for and how best to utilise it will help reduce costs and achieve better health results all year round. In this blog, we will take you through the key things that will help you get the most out of your medical aid plan benefits in 2025. The comparison tool MedicalAid.co.za will also help you understand your current plan and other available plans in the market. Do You Know What Your Plan Covers? The first step in attaining maximum medical aid benefits is to understand what your medical aid plan entails. Most of the members tend to miss out on some benefits just because they do not know about them. There are important aspects to check:

Routine Check-ups: Most of the plans include annual wellness visits, which can serve as a measure to screen for health issues early.
Specialist Visits: Check if your health plan provides specialist visits if you need them.
Preventative Care Benefits: Most of the schemes will pay for screening examinations, flu shots, and immunisations.
Chronic Benefits: For chronic illness cases, ensure that your plan includes the drugs and interventions required.
Hospital Benefits: Find out what hospitalisation benefits are provided in your plan and also try to find out if there are any upper limits or co-payments.

In case you feel that your current plan is not sufficient to meet your medical needs, go ahead and use the free comparison tool at MedicalAid.co.za to compare your cover with others. This tool enables you to evaluate and contrast the various plans available in the market in order to settle for the one that applies best to your health status, lifestyle and finances. Do You Know About Your Preventative Care Benefits? One of the most useful, yet commonly overlooked, aspects of medical aid plans is the preventive healthcare benefits. These services are meant to promote well-being and reduce the likelihood of any serious health conditions, by identifying and treating problems before they develop fully. Benefits associated with preventative care encompass:

Screenings: Mammograms, pap smears, cholesterol checks, and more.
Vaccinations: Flu shots, COVID-19 vaccines, and travel vaccines.
Wellness Programs: Some plans, like Bonitas’ benefit booster or Discovery’s Wealth Fund, offer additional rewards for maintaining good health through regular screenings and wellness check-ins.

Utilising these benefits can improve your health as well as give you eligibility for various rewards and discounts. Don’t forget that some plans provide limited cover for preventive care services, so it is advisable to evaluate different plans in order to get one that meets your health requirements perfectly. Visit MedicalAid.co.za and use the free comparison to find out which plans give the best preventative care benefits in 2025.

The Importance of Staying Within Your Network of DSPs The majority of medical aid benefits use a designated service provider (DSP) model. These are the medical facilities or providers such as doctors, specialists, hospitals and pharmacies that are contracted by your medical aid. It is very important to adhere to this network in order to avoid any out-of-pocket expenses that may be unplanned. For example, most medical aids will request you to choose a GP who will be your Primary Health Care Provider. You may receive co-payments or additional fees if you access services outside the designated network. Understanding where the closest DSP facilities, including a hospital, general practitioner, dentist, and even pharmacy, is located can help in reducing costs throughout the year. Planning to Bring a New Family Member Into the World? Plan Ahead

Adding to the family in 2025? Then it is important to ensure that your medical aid plan includes maternity cover. Do not however forget the terms and conditions, especially if you are already expectant – many medical aids operate on a 12-months maternity waiting period. To maximise the maternity benefits you receive, consider these factors:

Pre- and Post-Natal Care: Check whether your plan includes medical consultations, scans and any other pregnancy-related tests, if any, through the course of your pregnancy.
Maternity Benefits: Find out about hospital services, expenses related to the delivery and other options covered by the plan like prenatal education, or care services after the delivery.
Co-payments and Excess Fees: Check if there other limits above which your medical scheme will not pay which need to be accounted for in your budget.

If you are thinking of changing plans so that you can have more maternity benefits, look for a plan that suits you using MedicalAid.co.za’s comparison tool. Remember that changing medical aids when you are already pregnant may come with disadvantages as new waiting periods may apply. Therefore, it is usually advisable to remain on the existing plan if the situation allows it. Maximise Your Medical Aid Benefits in 2025 with MedicalAid.co.za Planning and utilising any medical aid plan to its fullest, will certainly enhance your healthcare experience in 2025. Whether it’s making sure you use any of the preventive care services available, staying within the designated service provider network, or strategising for a life event such as becoming pregnant are all ways you can maximise your benefits. The MedicalAid.co.za free comparison tool offers you a side by side comparison of various medical aid plans. View differences, evaluate your benefits and find the best suited cover for you. Take charge of your health care in 2025 – begin by comparing medical aid schemes through MedicalAid.co.za!