When can you upgrade or change your medical aid plan, and how to decide

Reviewed by Lincoln O’Ehley, General Manager at MedQuote

Published by MedicalAid.co.za | Last updated: 12 October 2026

MedicalAid.co.za is a free comparison service. It is not a medical scheme and does not provide cover.

That is the short answer. The longer one matters, because schemes publish next year’s changes at different points during the benefit review season, so the gap between having the information and having to decide can be short. This page sets out the dates, what changes, and five checks to do before you make your decision.

When you can change your plan: the annual option-change window

Medical schemes operate under the Medical Schemes Act 131 of 1998 and are regulated by the Council for Medical Schemes. The Act sets no national date for changing options. Each scheme submits its proposed premium increases and benefit changes to the Council, but schemes can decide when to open their option-change window.

If you don’t want to stay on your option, then there is one of two changes you’re able to make:

• Changing option on your current scheme. During the annual window, or mid-year on a motivated application.
• Changing to a different scheme. You can apply at any time of year, the acceptance of which is subject to underwriting and waiting periods. Most do it at review season.

The annual cycle is consistent across schemes even though the dates are not:

1. The scheme submits next year’s contributions and benefits to the Council for review.
2. The scheme notifies members of what is changing on each option, usually between September and November.
3. The window opens, and members may move between options or to another scheme.
4. The window closes. Changes usually take effect on 1 January, though a scheme can defer an increase.

Why the window is shorter than it looks

The window in the table below can run for weeks, but the useful part of it is shorter. Schemes publish next year’s contributions and benefit changes at different points, generally between September and November, so the time you have to compare is often shorter than the window in which you can change.

A scheme cannot ask members to choose until next year’s contributions and benefits have cleared the Council’s annual review. It then has to load the new option, move registrations, and let employers adjust payroll before 1 January.

Two dates are worth asking your scheme for: the closing date of the window, and any earlier deadline for submitting a change so it can be processed before 1 January.

Option-change windows by scheme

Listed alphabetically. The order is not a ranking. These are among the larger open schemes, not a complete list of those in South Africa.

Maintained by MedicalAid.co.za. Dates accurate as of 9 October 2026. Schemes marked as not yet announced will be added as they announce. Dates change annually and schemes sometimes extend a window at short notice. Contribution increases and benefit changes do not always take effect on the same date.

Can you change your plan during the year?

Yes, but acceptance of your application isn’t guaranteed. A mid-year option change needs a motivated application your scheme approves, on grounds set out in its rules. Those rules differ by scheme, including whether a downgrade is treated differently from an upgrade.

Reasons commonly considered by the scheme:

• Moving to another province where you will need a different network list for designated service providers. For example, if you were on a plan that focused on a coastal network, but you move inland then you need a plan that has a network focused on inland providers.
• A life-changing event, such as pregnancy, marriage or a new medical diagnosis (e.g., cancer).
• A change in employment, where you join or leave an employer group with its own options.

Where a scheme discontinues or restructures your option it will tell you and offer a replacement, under the rules it registers with the Council. If you do not respond you are usually moved onto it automatically.

“Members are often moved onto a replacement option without realising it, because the notice reads like administration rather than a decision, so ensure that you understand how your current plan may be impacted for the following benefit year,” says Lincoln O’Ehley, General Manager at MedQuote.

Changing to a different scheme is less restricted. You can apply at any time of year, approval of which is subject to underwriting and waiting periods, covered on MedXpert’s guide to waiting periods and underwriting.

What actually changes at review season

Five things are reviewed annually and your contribution is only one of them.

1. Your contribution. Increases are announced and are subject to approval by the Council for Medical Schemes.
2. The benefit structure of your option. Limits, sub-limits, savings allocations, and co-payment rules can all change, so assess whether the new benefits offer sufficient value for money.
3. Which options exist. Schemes close, merge and restructure options. An example of the latter would be changing an option from a traditional structure to a savings-focused structure.
4. The provider network. Provider arrangements are renegotiated annually, so your current provider might not be on the list for the next year.
5. The medicine formulary. The list of medicines covered in full is reviewed annually. If your current medicine isn’t approved, then look at whether a generic will be covered. If neither is covered by the plan, then you will need to cover those costs out-of-pocket.

The decision: five checks to run against your current plan

The big question is whether your plan’s changes will still meet your needs. The first four checks need only your scheme’s information.

Check 1. Has your usage changed since you chose this option?

Pull your last twelve months of claims from your scheme’s app and see where the money went. If day-to-day claims have grown while hospital claims stayed at zero, or the reverse, you might benefit from a different type of plan that has a greater focus on day-to-day benefits.

Check 2. Has your option’s benefit structure changed for the coming year?

Read the benefit change communication, not only the contribution letter. Having a good idea of how your plan has changed will help you understand if your new benefits fit your needs. Was there a reduced sub-limit, or an added co-payment, or a change in Savings allocation? How was my chronic care programme changed and what can I expect from the network list? These are all checks worth making.

Check 3. Are your providers still in network?

Check your GP, specialist, hospital and pharmacy against next year’s network list. If your GP has been removed from the network and you continue to consult with them then you’ll need to shoulder the additional costs.

Check 4. Is your chronic medicine still on the formulary?

If you or a dependant is registered for chronic medication, check each item against the formulary for the option you will be on in January.

Check 5. Would the same contribution buy a different type of plan?

Look at your contribution and compare it against other plans with a similar contribution, be it with your scheme or with another scheme, and look at what benefits that plan has vs what your plan has. Are you able to extract the same value for money on a Savings option vs a Traditional one? The point is not a premium, but the value for money.

Upgrade, downgrade, change scheme or stay

No single answer fits everyone.

Your review-season checklist

Six steps, in order, before your scheme’s window closes.

1. Find your scheme’s closing date and ensure your application is submitted well before then.
2. Work through the five checks above with a specific focus on your claim patterns and your needs.
3. Add up what you paid out of pocket this year.
4. Compare against the other options on your scheme at a similar contribution.
5. Compare across other open schemes at a similar contribution.
6. Submit your change in writing before the closing date and keep the confirmation.

If you decide to move, and by when

Changing options on your current scheme is the simpler route. Complete the form before the closing date, make a note of your query number and keep an eye on your inbox for your new membership certificate.

If you register chronic medication, you need to ensure that your condition and medicine are authorised for the new year. This includes ensuring that your network pharmacy has the most recent script. If your network pharmacy needs to deliver your medication each month then confirm the delivery address and if any co-payments will be applicable for the new year.

Changing scheme involves underwriting and follows a unique process, so start early if it’s something you want to do. You can compare open medical schemes side by side on MedicalAid.co.za, free of charge, and request a call back.

Frequently asked questions