Medical aid in South Africa: how it works
What is medical aid?
Medical aid is cover from a medical scheme registered with the Council for Medical Schemes under the Medical Schemes Act 131 of 1998. You pay a monthly contribution and the scheme pays for the health services listed in your benefit option, within its rules.
How much does it cost?
It depends on the scheme and the option. The Council for Medical Schemes reports a weighted average gross contribution of R2 839 per beneficiary per month for 2026 (open schemes R3 146, restricted schemes R2 434). By law a scheme may set contributions only by income and number of dependants, not by age or health.
Who regulates it?
The Council for Medical Schemes (CMS). As at 31 March 2026 it oversaw 70 registered schemes, 16 open and 54 restricted, covering about 9.17 million beneficiaries. Brokers and brokerages must be accredited by the CMS and licensed by the FSCA.
Contributions and benefits differ widely between options. A quote from a CMS accredited Advisor costs you nothing extra: the scheme pays the broker fee, capped at R125.86 plus VAT per member per month from 1 January 2026.
What you need to know about medical aid cover
In short
- Medical aid is regulated cover from one of 70 registered medical schemes: 16 open to the public and 54 restricted to an employer or group (CMS, as at 31 March 2026).
- Every option on every scheme must pay in full for the Prescribed Minimum Benefits: 271 listed conditions, 26 chronic conditions and emergency medical conditions.
- When you join, a scheme may apply a general waiting period of up to 3 months and a condition specific waiting period of up to 12 months. Joining at 35 or older without previous cover can add a late joiner penalty of 5 to 75 percent.
- You may belong to only one medical scheme at a time (section 28 of the Act).
- The medical scheme fees tax credit for the 2026/27 tax year is R376 a month for each of the first two people covered and R254 for each further dependant (SARS).
Disclosure. Medaid Quote is a comparison website and does not give financial advice. Quote requests made through this site are handled by our advice partner, Curemed (Pty) Ltd, FSP 44098, an independent medical aid brokerage. Curemed appears in comparisons where it meets the inclusion rule. Every figure is from the named public source on the stated date.
What are the main types of benefit option?
Schemes sell cover as benefit options. The law does not define option types; the names below are the ones schemes commonly use, and the detail is always in the scheme rules.
- Hospital plans cover treatment in hospital, plus the Prescribed Minimum Benefits that every option must cover. Day to day care such as GP visits and medicine outside hospital is mostly paid by the member. Contributions are generally lower than on options with day to day cover.
- Comprehensive options without savings (often called traditional options) pay day to day benefits from the scheme risk pool, subject to the limits and sub limits in the rules, as well as hospital cover.
- Savings options add a personal medical savings account. Part of your contribution, at most 25 percent of the gross contribution under Regulation 10, goes into the account and pays day to day claims until it runs out. Savings may not be used to pay for Prescribed Minimum Benefits.
Whatever the option, read the rules for co-payments, limits and the designated service providers the scheme uses, because these decide what you pay from your own pocket.
Key facts about medical schemes in South Africa
- 70 medical schemes were registered as at 31 March 2026: 16 open and 54 restricted (CMS Annual Report 2025/26).
- Open schemes accept any applicant. Restricted schemes are limited to the employees or members of a particular employer, industry, union or association.
- You may not be a member of more than one medical scheme, or claim from a scheme you do not belong to (section 28 of the Medical Schemes Act).
- The Council for Medical Schemes (CMS) regulates schemes, brokers and administrators under the Medical Schemes Act 131 of 1998. The General Regulations were published on 20 October 1999 and came into operation from 1 November 1999 and 1 January 2000.
- Every benefit option must pay in full for the Prescribed Minimum Benefits: 271 listed conditions, 26 chronic conditions and any emergency medical condition (Regulations 7 and 8).
- Waiting periods: a scheme may impose a general waiting period of up to 3 months and a condition specific waiting period of up to 12 months (section 29A). If you move from another scheme within 90 days, the Prescribed Minimum Benefits stay covered during any waiting period.
- Co-payments and limits apply outside the Prescribed Minimum Benefits, and a scheme may require you to use its designated service providers for PMB treatment. Choosing another provider voluntarily can mean a co-payment.
- Joining at 35 or older without continuous previous cover can attract a late joiner penalty of 5, 25, 50 or 75 percent of the contribution, depending on the years without cover (Regulation 13).
Open or restricted scheme: which can you join?
Restricted schemes are set up for the employees or members of a particular employer, industry, union or association. You can join only if you qualify under the scheme rules, usually through your job. There were 54 restricted schemes as at 31 March 2026; in 2024 they covered about 4.4 million beneficiaries (CMS Industry Report 2024).
Open schemes accept applications from the public. There were 16 open schemes as at 31 March 2026, covering about 4.7 million beneficiaries in 2024. Open schemes are the ones a comparison or a broker quote can cover; a restricted scheme is reached through the employer.
Medaid Quote compares open scheme options. Fill in the quote form and an accredited Advisor at our advice partner, Curemed (Pty) Ltd, FSP 44098, will send you the options that fit your budget.
How to check this yourself
- Is the scheme registered? The CMS publishes the list of registered medical schemes in its Annual Report on medicalschemes.co.za. Only a registered scheme may offer medical aid.
- Is your broker accredited? Search the CMS Accreditation Portal for the brokerage (ORG number) and the individual Advisor (BR number), and the FSCA FSP search for the licence. Our guide to checking a medical aid broker walks through both.
- What does the option actually cover? Ask for the scheme rules and the benefit schedule for the option, not only the brochure. Check the designated service providers for PMB treatment, the co-payments and the savings share.
- What will you pay? Ask for the contribution for your income band and number of dependants, any late joiner penalty and any waiting periods. Our guide to reading a medical aid quote explains each line.
Frequently asked questions
Can I take Gap Cover instead of medical aid?
No. Gap Cover is a short term insurance policy that supplements medical scheme cover by paying the difference between what the scheme pays and what a provider charges for certain in hospital events. It pays only while you are a member of a medical scheme and is not a substitute for one.
Does the medical scheme fees tax credit reduce my contribution?
No. It reduces your income tax. For the 2026/27 tax year SARS allows R376 a month for each of the first two people covered and R254 for each additional dependant, claimed by the taxpayer who pays the contributions.
Can a scheme charge me more because of my age or health?
No. Section 29(1)(n) of the Medical Schemes Act allows contributions to differ only by income and number of dependants. The late joiner penalty under Regulation 13 is the one exception, for people who join at 35 or older without previous cover.
What happens to my waiting periods if I change option or scheme?
Changing option within your scheme carries no new waiting period. If you move to another scheme within 90 days of leaving the old one, the new scheme may still impose waiting periods but must cover the Prescribed Minimum Benefits during them. After more than 24 months of continuous previous cover, only a general waiting period of up to 3 months may apply.
Who pays the broker?
The scheme pays the broker a monthly fee out of contributions, capped at R125.86 plus VAT per member per month from 1 January 2026 (Government Notice 7028 of 2026), or 3 percent of the contribution plus VAT if that is less. You do not pay extra for using a broker.
How many South Africans belong to a medical scheme?
About 9.17 million beneficiaries in 2024: 4.17 million principal members and 5.0 million dependants, according to the CMS Industry Report 2024.
Sources, all read on 14 October 2026: Council for Medical Schemes Annual Report 2025/26 (published 7 October 2026); CMS Industry Report 2024 (December 2025); Medical Schemes Act 131 of 1998, sections 28, 29(1)(n) and 29A; General Regulations GNR 1262 of 20 October 1999, Regulations 7, 8, 10, 11, 13 and 28; Government Gazette 54019, Notice 7028 of 27 January 2026; SARS medical tax credit rates, updated 25 February 2026.
Last reviewed: 14 October 2026. Figures are as at the dates stated.