By Tegan Botha, Medaid Quote. Reviewed by Roxanne Hurter-Ehlers.
In short
- A medical aid quote is built from standard parts: the option, a contribution per person, any savings portion, any late joiner penalty, your waiting periods and the broker details.
- By law a scheme may set contributions only by income, the number of dependants, or both. It may not charge you more for your age, sex or health, except through a late joiner penalty (Medical Schemes Act 131 of 1998, section 29(1)(n), and Regulation 13).
- A savings portion can be at most 25% of the total gross contribution and cannot be used to pay for Prescribed Minimum Benefits (Regulation 10).
- From 1 January 2026 the most a scheme may pay a broker is R125.86 plus VAT a month per member, or 3% plus VAT of that member contribution if that is less (Government Notice 7028 of 2026 and Regulation 28(2)).
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.
To read a medical aid quote, start with the option name and the year the prices apply to, then add up the contribution lines for each person, then look for three things that change what you actually pay or receive: a savings portion, a late joiner penalty and waiting periods. Finally, check who the broker is and that they are accredited. Below is each line, the rule behind it, and what to ask. The rules quoted were checked on 14 October 2026.
Which lines appear on a typical medical aid quote?
| Line on the quote | What it means | Rule behind it | What to check |
|---|---|---|---|
| Scheme and benefit option | The scheme and the specific option. Benefits and prices are set per option. | Registered scheme rules | The option name and year match the benefit brochure you were given. |
| Contribution year or start date | The period the prices apply to. | Registered scheme rules | The prices are for your start date. |
| Principal member contribution | The monthly amount for the main member. | Medical Schemes Act, section 29(1)(n) | The income band used, if any, is correct. |
| Adult dependant contribution | The monthly amount for each adult dependant. | Section 29(1)(n) | Each adult is counted once. |
| Child dependant contribution | The monthly amount for each child dependant. | Section 29(1)(n) and scheme rules | How the scheme defines a child dependant. |
| Risk and savings split | The part paying claims from the shared pool, and any part credited to your own savings account. | Regulation 10(1) and 10(6) | Savings is no more than 25% of the total gross contribution. |
| Late joiner penalty | An extra charge based on age at application and years of previous cover. | Regulation 13 | All previous cover was counted. |
| Waiting periods | General or condition-specific waiting periods, or none. | Medical Schemes Act, section 29A | Whether PMBs are covered during them. |
| Broker or Advisor details | The person and firm advising you. | Section 65; Regulation 28(2); Government Notice 7028 of 2026 | CMS accreditation for both. |
| Gap Cover or other add ons | A separate insurance product, if quoted. | Its own policy wording | It is a separate premium, not part of the scheme contribution. |
How are the contribution amounts worked out?
Section 29(1)(n) of the Medical Schemes Act says scheme rules must set contributions on the basis of income, the number of dependants, or both, and must not use any other ground, including age, sex or past or present state of health. So two people of different ages on the same option, income band and family size pay the same, unless a late joiner penalty applies.
To check the total, add the principal member line, each adult dependant line and each child dependant line. Here is a worked example with made up prices that belong to no real scheme: an option at R3,000 for the principal member, R2,400 for an adult dependant and R900 for each child gives R3,000 plus R2,400 plus two times R900, which is R7,200 a month for a couple with two children. If the totals differ, ask why.
Income banded options can cost lower earners less, but need proof of income. Options priced only by family size are simpler, with no discount for a lower income.
What does a savings line mean for day to day costs?
Some options split the contribution into a risk portion and a personal medical savings account. Regulation 10(1) caps the savings portion at 25% of the total gross contribution for the year. Regulation 10(6) says savings may not be used to pay for a Prescribed Minimum Benefit, so PMB claims must be paid from the risk portion.
The trade off: savings gives you control over day to day spending, but it is your own money paid in advance, and once it runs out you may pay day to day costs yourself until the next benefit year. A higher savings figure is not automatically better value; compare the risk benefits too.
Why might a quote include a late joiner penalty?
Regulation 13 lets a scheme add a penalty for a late joiner. The penalty applies only to the part of the contribution for that member or adult dependant, not to the whole family. The scheme works out the number of penalty years as age at application minus (35 plus the years of creditable cover you can show). The result decides the band below.
| Penalty years | Maximum penalty |
|---|---|
| 1 to 4 years | 5% of the contribution |
| 5 to 14 years | 25% of the contribution |
| 15 to 24 years | 50% of the contribution |
| 25 years or more | 75% of the contribution |
Example: a person who applies at 50 and can show 8 years of previous cover has 50 minus (35 plus 8), which is 7 penalty years. That falls in the 5 to 14 year band, so the scheme may add up to 25% to the contribution for that person. If you prove more cover later, Regulation 13(4) says the penalty must be recalculated from that date.
What do the waiting period notes on a quote mean?
Section 29A of the Medical Schemes Act sets the limits, which depend on your cover before you apply:
- No scheme cover for at least 90 days before applying: a general waiting period of up to three months and a condition-specific waiting period of up to 12 months (section 29A(1)). This subsection has no exception for Prescribed Minimum Benefits, so PMBs may be excluded during these periods.
- Previous cover for up to 24 months, ending less than 90 days before applying: a condition-specific waiting period of up to 12 months, but not for PMB treatment or diagnosis (section 29A(2)).
- Previous cover for more than 24 months, ending less than 90 days before applying: a general waiting period of up to three months, again not for PMB treatment or diagnosis (section 29A(3)).
- Changing option within the same scheme: no new waiting period, though any unexpired waiting period you are already serving may continue (section 29A(4)).
If a quote says only that underwriting applies, the waiting periods are set after the scheme reviews your application, so cover in the first months may be narrower than you expect.
Where does the broker fee sit on a quote?
Regulation 28(2) caps what a scheme may pay a broker for each member at the lesser of a gazetted amount and 3% plus VAT of that member contribution. Government Notice 7028 of 2026, published in Government Gazette 54019, set the amount at R125.86 plus VAT a month with effect from 1 January 2026.
A broker can compare options across schemes but is paid by the scheme you join; going direct means one less party, but the comparison work is yours. Section 65 of the Act allows only an accredited broker to be paid, so check the numbers on the CMS Accreditation Portal. The register comparison of independent medical aid brokers shows the same checks applied to several firms.
How to check this yourself before you accept a quote
- Get the benefit brochure for the exact option and year.
- Add the contribution lines yourself and compare your sum with the quoted total.
- If a savings figure is shown, check it is no more than 25% of the total and ask what happens when it runs out.
- If a late joiner penalty is shown, ask how many penalty years were used and give proof of every period of previous cover.
- Ask for the waiting periods in writing, and whether PMBs are covered during them.
- Look up the broker firm and the person on the CMS Accreditation Portal.
- Read any Gap Cover as a separate policy with its own terms.
For scheme and option basics, see the medical aid overview, and for more explainers, browse our guides.
Want a quote to read line by line? Request one and check each line against this guide, whichever route you choose.
Frequently asked questions
Can a medical scheme charge me more because of my age or health?
No. Section 29(1)(n) of the Medical Schemes Act limits contributions to income, the number of dependants, or both, and rules out age, sex and state of health. The exception is a late joiner penalty under Regulation 13.
Can I use my medical savings account to pay for a PMB?
No. Regulation 10(6) says savings may not be used to pay for a Prescribed Minimum Benefit.
Does a newborn baby have a waiting period?
No. Section 29A(5) says a scheme may not impose a waiting period on a child dependant born during the period of membership.
Who can claim the medical scheme fees tax credit?
The taxpayer who paid the contributions, not automatically the member. For the tax year 1 March 2026 to 28 February 2027, SARS lists R376 a month for the taxpayer, R376 for the first dependant and R254 for each additional dependant.
Last reviewed: 14 October 2026. Sources: Medical Schemes Act 131 of 1998, sections 29(1)(n), 29A and 65 (section 29A inserted by the Medical Schemes Amendment Act 55 of 2001); Medical Schemes Regulations 10, 13 and 28; Government Notice 7028 of 2026, Government Gazette 54019; SARS, Medical Scheme Fees Tax Credit, 2026/27 tax year.