How to get medical aid and medical insurance in South Africa
1.
Understand the Difference Between Medical Aid and Medical Insurance
Medical Aid:
Comprehensive health plan covering hospital visits, chronic medication, consultations, and sometimes day-to-day expenses depending on the plan. Requires membership in a registered medical scheme.
Medical Insurance / Gap Cover:
Supplements medical aid by covering costs that exceed your medical aid limits. Ideal if you have a medical aid plan but want extra protection.
2.
Determine Your Health Needs
Assess how often you visit doctors, specialists, or hospitals.
Consider chronic conditions requiring regular medication.
Decide if you want a hospital plan only or a comprehensive plan (hospital + day-to-day medical expenses).
3.
Research Medical Aid Schemes
Common schemes:
Discovery Health, Momentum Health, Bonitas, Medihelp, FedHealth, Bestmed.
Compare:
Monthly premiums
Co-payments or deductibles
Hospital coverage and networks
Day-to-day benefits
Chronic illness coverage
Estimated Monthly Premiums:
Hospital plan only: R1,500 – R3,500 per adult
Comprehensive plan: R3,500 – R7,500 per adult
Family plans: R5,000 – R12,000 depending on dependents and cover level
4.
Gather Required Documents
South African ID or valid passport
Proof of address (utility bill, lease agreement)
Banking details for debit orders
Employment information (if joining via employer)
Medical history or chronic medication details
5.
Choose Your Plan Level
Hospital Plans:
Cover major hospital expenses, more affordable
Comprehensive Plans:
Cover hospital and day-to-day expenses including doctor visits, prescriptions, and specialists
Gap Cover:
Optional extra for medical costs exceeding your plan limits
Tips:
Check which hospitals and doctors are included
Consider potential co-payments for procedures or specialists
Look at chronic medication coverage if needed
6.
Register With the Medical Aid Scheme
Steps:
Visit the scheme’s website or contact a broker/consultant
Complete the application form with personal details and plan selection
Submit supporting documents (ID, banking info, medical history)
Wait for approval; medical underwriting may be required
Once approved, receive membership number and medical aid card
7.
Set Up Payment
Monthly premiums usually via debit order
Employer deductions possible if joining through work
Keep payments up to date to maintain coverage
8.
Understand Your Benefits
Hospital cover: Admissions, surgery, ICU, maternity, emergencies
Day-to-day cover: GP visits, specialists, dentistry, optometry, physiotherapy
Chronic cover: Medication and specialist visits for chronic illnesses
Prescribed Minimum Benefits (PMBs): Mandatory coverage for certain conditions