Question 1

What is the cheapest medical aid in South Africa in 2026?

Accepted Answer

The five lowest monthly prices for a main member, from the schemes' official 2026 brochures: Momentum Ingwe — Connect Network: R1 252 a month; Bonitas BonCore: R1 275 a month; Discovery Health Active Smart: R1 350 a month; Momentum Ingwe — Ingwe Network: R1 425 a month; Bonitas BonStart: R1 603 a month. Cheapest isn't always best. It's like buying the cheapest pair of takkies: fine for walking, but they won't last a marathon. Cheap plans usually mean fewer hospitals and less cover outside hospital. Momentum Ingwe — Connect Network costs R1 252 a month, but check which hospitals you can use and what you'd pay for GP visits before you choose it. Compare plans by price on the Compare page.

Question 2

What is the cheapest hospital plan in 2026?

Accepted Answer

The lowest-priced hospital plans on PlainAid right now: Momentum Ingwe — Connect Network: R1 252 a month; Bonitas BonCore: R1 275 a month; Discovery Health Active Smart: R1 350 a month; Momentum Ingwe — Ingwe Network: R1 425 a month; Bonitas BonStart: R1 603 a month. A hospital plan is like insurance for the big stuff only. It pays when you're admitted, but you pay for the small things like a GP visit for flu. Bonitas BonCore covers hospital stays at network hospitals for R1,275 a month, but has a R5,500 co-payment per admission. A plan that costs a bit more might have no co-payment at all.

Question 3

What is the cheapest medical aid with a savings account?

Accepted Answer

The lowest-priced savings plans on PlainAid right now: Bonitas BonFit: R2 698 a month; Discovery Health Essential Smart Saver: R2 750 a month; Discovery Health Essential Delta Saver: R3 099 a month; Bonitas BonPrime: R3 255 a month; KeyHealth Equilibrium: R3 296 a month. It's a hospital plan that also gives you pocket money for the doctor and the pharmacy each year. On a savings plan, part of what you pay each month goes into your savings for GP visits and medicine. When it's used up, you pay those costs yourself until January.

Question 4

What is a medical aid?

Accepted Answer

A medical aid, or medical scheme, is a pool of money that thousands of people pay into every month. When one of them gets sick or needs care, the pool pays the bills, according to the rules of their plan. Medical schemes are non-profit and are regulated by the Council for Medical Schemes. In simple terms: Imagine your whole school puts R10 into a jar every month. If someone breaks an arm, the jar pays for the X-ray and the hospital. Most months nothing happens, but when it does, nobody has to stress about money. Medical aid is that jar, for adults, and it costs more than R10. Example: You and hundreds of thousands of other members each pay a monthly contribution. If you need a hip replacement that costs R150,000, the scheme pays it from the pool. You couldn't save R150,000 on your own, but together everyone covers each other.

Question 5

What is a medical aid contribution or premium?

Accepted Answer

Your contribution (also called a premium) is the amount you pay every month to stay on your medical aid, whether you use it or not. It's quoted separately for the main member, each adult dependant and each child. In simple terms: It's like a monthly cellphone contract. You pay every month even if you hardly use your phone, but when you need it, it's there. Example: Bonitas BonCore costs R1,275 a month per person in 2026. You pay that every month. If you then need a hospital stay costing R40,000, BonCore pays it (after a R5,500 co-payment per admission on that plan).

Question 6

What is a medical aid plan or option?

Accepted Answer

Each medical scheme offers several plans (also called options), from basic hospital-only plans to comprehensive ones. Each plan has its own price and its own list of what's covered. In simple terms: Think of a takeaway menu: the same restaurant sells a small, medium and large meal. The scheme is the restaurant; the plans are the meal sizes. Example: Discovery is one scheme, but it has 25 plans on PlainAid, from Active Smart at R1,350 a month to Executive at R12,338 a month.

Question 7

Who is the main member on a medical aid?

Accepted Answer

The main member (principal member) is the person whose name the membership is in. They pay the contributions and can add a spouse, partner or children as dependants. In simple terms: It's like the person whose name is on the family Netflix account. Everyone else is added under them. Example: Thandi joins Medihelp MedVital as the main member and adds her husband and two children. The whole family is on one membership in Thandi's name.

Question 8

What is a dependant on medical aid?

Accepted Answer

A dependant is someone covered on your membership: an adult dependant (a spouse or partner) or a child dependant. Everyone covered, including the main member, is called a beneficiary. In simple terms: You're the main character; your family members are the extras who get to ride along on your ticket. Example: On Bestmed Beat 2 in 2026 the main member pays R3,084, an adult dependant R2,395 and each child R1,299 a month. A couple with one child pays R6,778 a month.

Question 9

How much do children cost on medical aid?

Accepted Answer

Children pay a lower rate. Many schemes only charge for the first two or three children, so more children are free. Child rates usually last until 21, 24 or 26, depending on the scheme. In simple terms: It's like a family movie deal: kids get cheaper tickets, and on some deals the fourth kid gets in free. Example: On Bonitas plans you pay for a maximum of three children, so a fourth child is covered for free. On KeyHealth Essence, every child is charged R862 a month.

Question 10

What is a medical aid benefit year?

Accepted Answer

Your limits and savings run for a benefit year, usually 1 January to 31 December. In January everything resets. If you join mid-year, most limits are reduced in proportion to the months left. In simple terms: Like a data bundle that renews every January. Use it all by December and you wait for the new year. Example: Your plan has an optical limit of R2,000 a year. You spend it in March on glasses. You can't claim new glasses again until 1 January.

Question 11

When can I change my medical aid plan?

Accepted Answer

Most schemes let you change to another of their plans once a year, from 1 January, if you tell them before their deadline (usually November or December). Moving to a different scheme is possible during the year, normally with a month's notice, but waiting periods may apply. In simple terms: It's like changing subjects at school: you can only do it at the start of the year, and you have to ask before the cut-off date. Example: You're on Momentum Custom and want Momentum Incentive from next year. You ask Momentum before their deadline in late 2026, and the change starts on 1 January 2027.

Question 12

Why do some medical aids charge according to income?

Accepted Answer

Some entry-level plans charge less if your household earns less, so more people can afford cover. You need to prove your income when you join. In simple terms: It's like a sliding-scale school fee: families who earn less pay less for the same school. Example: Momentum Ingwe on the Connect Network costs R1,079 a month if the household earns up to R1,550, but R3,302 a month above R23,500 in 2026. Same plan, different price.

Question 13

What's the difference between medical aid and medical insurance?

Accepted Answer

Medical aid pays your actual medical bills and must cover the Prescribed Minimum Benefits. Medical insurance (like hospital cash plans or gap cover) is a different product: it pays fixed amounts or shortfalls, and doesn't replace medical aid. In simple terms: Medical aid is the full meal. Medical insurance is a side order: nice to have, but it won't fill you up on its own. Example: A hospital cash plan might pay you R1,500 for each day you're in hospital. If the hospital bill is R80,000, that R1,500 a day won't come close. Medical aid pays the bill itself.

Question 14

What is a hospital plan?

Accepted Answer

A hospital plan covers you when you're admitted to hospital and for certain major events. Day-to-day costs such as GP visits and medicine are mostly yours, apart from the Prescribed Minimum Benefits. In simple terms: It's like car insurance that only pays if you crash, not for petrol or a service. Example: On a hospital plan like Discovery Classic Core (R3,905 a month), an operation and hospital stay are covered, but a R600 GP visit for flu comes out of your own pocket.

Question 15

What is a medical aid savings plan?

Accepted Answer

A savings plan is a hospital plan with a medical savings account added, so you can pay day-to-day costs from it. When the savings run out, you usually pay yourself until the new year. In simple terms: It's a hospital plan with pocket money attached. Spend the pocket money wisely, because when it's gone, it's gone until January. Example: Medihelp MedSaver (R4,260 a month) puts 25% of your contribution into savings: R12,744 a year for a single member. GP visits and medicine are paid from that.

Question 16

What is a comprehensive medical aid plan?

Accepted Answer

A comprehensive plan covers hospital, day-to-day costs and extras such as more chronic conditions and higher limits for dentistry, glasses and specialists. It costs the most. In simple terms: The all-you-can-eat buffet of medical aid. Great if you use a lot, expensive if you don't. Example: Bestmed Pace 4 (R12,572 a month) has an overall day-to-day limit of R45,375 for a single member (R73,172 for a family) and covers 29 extra chronic conditions on top of the standard list.

Question 17

What is a network plan?

Accepted Answer

A network plan only fully covers you at the scheme's chosen hospitals, GPs or specialists. That's why it costs less. Using someone else for planned treatment means a co-payment or no cover at all. In simple terms: It's like a student discount that only works at certain shops. Shop elsewhere and you pay full price. Example: Bestmed Beat 1 Network costs R2,269 a month versus R2,523 for Beat 1. The catch: if you choose a hospital outside the network for a planned operation, you pay a R15,025 co-payment.

Question 18

What's the difference between an open and a restricted medical scheme?

Accepted Answer

An open scheme must accept anyone who applies. A restricted (closed) scheme is only for a certain group, such as employees of one company or one industry. In simple terms: An open scheme is a public school; a restricted scheme is a company club only staff can join. Example: Anyone can join Discovery, Bonitas or Medihelp. A mining company's own scheme only accepts that company's employees and their families.

Question 19

What is a hospital cash plan?

Accepted Answer

A hospital cash plan is an insurance policy that pays you a fixed amount for each day you're in hospital. It isn't medical aid and doesn't pay the hospital bill. In simple terms: It's like getting a small payout for every day you're stuck in bed. Nice, but it doesn't pay the doctor. Example: You're in hospital for 4 days and your cash plan pays R1,000 a day: R4,000 to spend on transport or lost income. The R60,000 hospital bill still needs medical aid.

Question 20

What are day-to-day benefits?

Accepted Answer

Day-to-day benefits pay for costs outside hospital: GP and specialist visits, medicine, blood tests, X-rays, dentistry and glasses. Depending on the plan they come from savings, from an insured limit, or not at all. In simple terms: Everything you'd normally pay for at the doctor, pharmacy or optometrist, not the big hospital stuff. Example: On Bonitas Standard, a family with 3 or more dependants has a day-to-day limit of R25,640 for 2026, which pays for GP visits, specialists, medicine, X-rays and blood tests.

Question 21

What is a medical savings account (MSA)?

Accepted Answer

Part of your contribution goes into a savings account for your own day-to-day costs. By law it can't be more than 25% of your contribution. Most schemes give you the full year's savings in January, and what you don't use carries over. In simple terms: It's like your parents giving you a year's pocket money upfront in January. Spend it on the doctor and the pharmacy; whatever's left rolls over to next year. Example: On Discovery Classic Comprehensive, 25% of your contribution goes to savings: R29,550 for the main member in 2026. If you only use R20,000, the R9,550 carries over to 2027.

Question 22

What happens if I use my savings and then leave my medical aid?

Accepted Answer

Because you get the full year's savings in January, you can spend money you haven't paid in yet. If you leave during the year after using more than you've contributed, you must pay the difference back. In simple terms: It's like borrowing next month's allowance. If you quit the house rules in June, you owe the money back. Example: Your savings are R12,000 a year (R1,000 a month). You use all R12,000 by March, then leave in April. You've only paid in R4,000, so you owe the scheme R8,000.

Question 23

What is an insured or risk benefit?

Accepted Answer

An insured (risk) benefit is paid from the scheme's pooled money, not your own savings. Day-to-day limits like "GP visits up to R5,000" are usually insured benefits. In simple terms: Savings are your own money. Insured benefits are the scheme's money that it promises to spend on you. Example: Medihelp MedVital gives an insured day-to-day amount of R1,575 a year for a single member. It doesn't come out of savings, because MedVital has none.

Question 24

What is a self-payment gap?

Accepted Answer

On some plans, once your savings run out you pay day-to-day costs yourself until your claims reach the annual threshold. Then extra cover kicks in. You must still send claims to the scheme so they count. In simple terms: It's like a level in a game you have to get through on your own before you unlock the bonus round. Example: On Momentum Extender, the 2026 threshold for a single member is R36,900. If your savings are about R34,400, you pay the next R2,500 of claims yourself, then Extended Cover starts paying.

Question 25

What is the annual threshold on medical aid?

Accepted Answer

The annual threshold is how much your day-to-day claims must add up to in a year before above-threshold cover starts paying. It depends on how many people are on your membership. In simple terms: It's the finish line you need to reach before the scheme starts paying again. Example: On Discovery Executive the 2026 threshold is R42,570 for an adult. Once your claims pass that, the Above Threshold Benefit pays day-to-day claims with no overall limit.

Question 26

What is the Above Threshold Benefit?

Accepted Answer

The Above Threshold Benefit (Momentum calls it Extended Cover) is extra day-to-day cover that starts once your claims reach the annual threshold. On some plans it's unlimited; on others it has a limit. In simple terms: The bonus round. Once you've cleared the threshold, the scheme starts paying your day-to-day costs again. Example: On Discovery Classic Priority, the Above Threshold Benefit pays up to R20,080 for the main member in 2026, after the R27,160 threshold is reached.

Question 27

What is Discovery's Day-to-day Extender Benefit?

Accepted Answer

It's a Discovery benefit that pays for certain network GP visits and essential care after your savings have run out, so you're not left with nothing during the self-payment gap. In simple terms: A small safety net under the gap: a few free doctor visits even when your pocket money is gone. Example: On Discovery Classic Saver, once your savings are used up, the Extender Benefit still covers 3 network GP consultations a year (6 for a family).

Question 28

What is a Personal Health Fund or Benefit Booster?

Accepted Answer

Some schemes give extra money for day-to-day costs when you do health checks or challenges. Discovery calls it the Personal Health Fund, Bonitas the Benefit Booster and KeyHealth the Health Booster. In simple terms: It's like earning extra airtime by doing your steps every day. Look after yourself and the scheme gives you more to spend. Example: On Bonitas BonEssential, completing a wellness screening and an online mental health check unlocks a R1,160 Benefit Booster for GP visits and medicine in 2026.

Question 29

What's the difference between a per person and a per family limit?

Accepted Answer

A per person limit applies to each beneficiary separately. A per family limit is shared, so one person can use all of it. In simple terms: Per person is everyone getting their own slice of pizza. Per family is one pizza for the table: if your brother eats it all, there's none left. Example: Bonitas BonClassic covers specialised dentistry up to R7,710 per family a year. If one child needs braces costing R7,710, nobody else in the family can claim specialised dentistry that year.

Question 30

Does medical aid pay for over-the-counter medicine?

Accepted Answer

Over-the-counter (OTC) medicine is what you can buy without a prescription. Some plans give a small yearly amount for it; on others it comes from savings or your own pocket. In simple terms: The stuff you grab at the pharmacy for a headache or a cold, without seeing a doctor. Example: Discovery Classic Smart gives up to R905 per family a year for over-the-counter medicine at a network pharmacy in 2026.

Question 31

Does medical aid cover virtual doctor consultations?

Accepted Answer

A virtual consultation is a video or phone appointment with a GP or nurse. Many plans now cover a number of these, sometimes with no limit. In simple terms: A FaceTime call with a doctor instead of sitting in a waiting room. Example: Bonitas BonCore includes unlimited virtual GP consultations in 2026, plus 3 in-person GP visits per person a year.

Question 32

Does medical aid pay for check-ups and screenings?

Accepted Answer

Most schemes pay separately for preventive care such as blood pressure, cholesterol and glucose checks, Pap smears, mammograms and flu vaccines, so it doesn't use up your savings or day-to-day limits. In simple terms: It's like a car's free service check: catch a small problem before it becomes a big one. Example: On Momentum plans, a yearly health assessment at Dis-Chem, Clicks or a MediRite pharmacy clinic is covered for every adult, without touching your savings.

Question 33

What does the hospital benefit cover?

Accepted Answer

The hospital benefit covers your stay: the ward, theatre, medicine in hospital and the doctors who treat you. Most plans have no overall limit, but some things have their own sub-limits. In simple terms: Everything that happens from the moment you're admitted until you go home. Example: You have your appendix out. The hospital, theatre, surgeon, anaesthetist and medicine come to R65,000. Your hospital benefit pays it, apart from any co-payment or shortfall your plan has.

Question 34

What is pre-authorisation?

Accepted Answer

Pre-authorisation is permission from your scheme before a planned admission, scan or procedure. You phone or use the app and get an authorisation number. Without it the scheme can pay less, or nothing. In simple terms: Like asking your parents before you book a holiday on their card. Ask first, or you might be paying yourself. Example: On Momentum plans, if you don't get pre-authorisation for a planned admission, the scheme pays only 70% of the account (except in an emergency).

Question 35

What's the difference between a planned and an emergency admission?

Accepted Answer

A planned (elective) admission is booked ahead, such as a knee operation, and needs pre-authorisation. In a real emergency you can go to the nearest hospital, and you or the hospital tell the scheme as soon as possible, usually within 48 hours or the next working day. In simple terms: Planned is booking a table at a restaurant. Emergency is the fire alarm going off: you just go. Example: You're in a car accident and taken to the nearest hospital, which isn't on your network. Because it's an emergency, you're covered there. A planned hip replacement, though, must be at a network hospital.

Question 36

What is a day hospital?

Accepted Answer

A day hospital is a clinic for procedures where you go home the same day, such as scopes, cataract surgery or tonsils. Many plans require these procedures to be done in a day hospital, or charge a co-payment if they're done in a full hospital. In simple terms: In the morning, home by supper. No overnight stay needed. Example: On Bestmed plans, if a day procedure is done in a full (acute) hospital instead of a day hospital, you pay a R2,872 co-payment in 2026.

Question 37

What is an upfront payment on medical aid?

Accepted Answer

An upfront payment is a fixed amount you pay the hospital before a planned admission or procedure, even though you're covered. Schemes use them for certain operations, for hospitals outside the network, or for scans. In simple terms: Like a deposit you pay before the work starts. The scheme covers the rest. Example: On Discovery Classic Smart, a planned admission at a hospital outside the Smart Hospital Network means paying R12,650 upfront in 2026.

Question 38

Does medical aid cover scopes (gastroscopy and colonoscopy)?

Accepted Answer

Scopes are tests where a camera looks inside your stomach (gastroscopy) or bowel (colonoscopy). Many plans have a specific co-payment for scopes, which is lower in a day clinic or the doctor's rooms than in a full hospital. In simple terms: A tiny camera on a tube that lets the doctor see what's going on inside. Example: On most Discovery plans in 2026, a scope in a day clinic has a R4,650 co-payment, and doing it outside the Day Surgery Network costs R7,250 upfront.

Question 39

Does medical aid pay for MRI and CT scans?

Accepted Answer

MRI and CT scans need pre-authorisation. Most plans have a yearly limit, a co-payment per scan, or both. Ordinary X-rays are called basic radiology and are usually cheaper to claim. In simple terms: Super-detailed photos of the inside of your body, and they're expensive, so the scheme wants to know first. Example: Bonitas BonClassic covers MRI and CT scans up to R37,800 per family in 2026, with a R2,800 co-payment per scan.

Question 40

What is a prosthesis limit?

Accepted Answer

An internal prosthesis is a device placed in your body, such as a hip or knee replacement, pacemaker or stent. An external prosthesis is outside the body, such as an artificial leg. Plans usually set a limit for each. In simple terms: Replacement parts for the body, and like car parts, they can be very expensive. Example: Medihelp MedAdd covers internal prostheses up to R81,200 per person in 2026. If a knee replacement device costs R95,000, you pay the R13,800 difference.

Question 41

Does medical aid pay for a private ward?

Accepted Answer

Medical aid normally pays for a general (shared) ward. A private room usually costs extra, unless your plan says otherwise. In simple terms: Medical aid pays for a dorm room. If you want your own room, that's usually extra. Example: Discovery Executive and Classic Comprehensive pay for a private ward after childbirth, up to R2,800 a day in 2026. On most other plans, a private room is at your cost.

Question 42

What is step-down care?

Accepted Answer

Step-down care is care after a hospital stay, or instead of one: a step-down facility, home nursing, hospice or care at home. It's usually covered up to a limit, with pre-authorisation. In simple terms: The halfway house between hospital and home, while you get strong enough. Example: Momentum Incentive covers medical rehabilitation, private nursing, hospice and step-down care up to R70,000 per family in 2026.

Question 43

Does medical aid pay for medicine when I leave hospital?

Accepted Answer

Take-home medicine (TTO, "to take out") is what the hospital gives you when you're discharged. Most plans cover a few days' supply up to a set amount per admission. In simple terms: The goodie bag of medicine you get when you leave hospital, but with a spending limit. Example: KeyHealth plans pay for medicine on discharge up to R695 per admission in 2026.

Question 44

Does medical aid pay for an ambulance?

Accepted Answer

Medical aid usually covers emergency transport by ambulance or helicopter through its contracted provider, such as Netcare 911 or ER24, normally in full within South Africa. In simple terms: If you need an ambulance in an emergency, you phone the number on your card and the scheme pays. Example: Medihelp plans cover emergency transport through Netcare 911 with no limit in South Africa and neighbouring countries in 2026. Outside your country of residence: R2,600 for road and R17,700 for air.

Question 45

Does medical aid pay for casualty (ER) visits?

Accepted Answer

A casualty visit is going to a hospital's emergency unit without being admitted. Many plans only cover a few a year, or pay them from day-to-day benefits, unless it's a real emergency. In simple terms: Going to the ER for stitches and going home the same night. Example: Bonitas plans cover 2 emergency room visits per family a year in 2026, and some plans add 2 more for children under 6.

Question 46

What are Prescribed Minimum Benefits (PMBs)?

Accepted Answer

PMBs are care that every scheme must cover by law, on every plan: emergencies, about 270 serious conditions and their treatment, and the conditions on the Chronic Disease List. You may need to use the scheme's chosen providers and medicine list to be covered in full. In simple terms: The rules say every plan, even the cheapest, must cover these. It's the safety net nobody can take away. Example: Even on the cheapest hospital plan, a heart attack is a PMB: the emergency treatment must be covered, as long as the scheme's rules (like using its chosen hospitals afterwards) are followed.

Question 47

What is the Chronic Disease List (CDL)?

Accepted Answer

The CDL is the list of common chronic conditions all schemes must cover, including diabetes, hypertension, asthma, epilepsy, high cholesterol and HIV. Schemes count it as 26 or 27 conditions depending on how they list them. In simple terms: The official list of long-term conditions where the scheme has to help with your monthly medicine. Example: If you have type 2 diabetes, it's on the CDL. On every plan, your approved diabetes medicine is covered once you register it, as long as it's on the scheme's medicine list.

Question 48

What are additional chronic conditions?

Accepted Answer

Some plans cover extra chronic conditions on top of the CDL, such as ADHD, depression, acne or osteoporosis. They're usually on mid-range and comprehensive plans, often with a yearly limit. In simple terms: Bonus conditions the cheaper plans don't cover. Example: Momentum Extender covers 62 chronic conditions in 2026: the 26 on the CDL with no limit, plus 36 more up to R13,700 per family a year.

Question 49

How do I register a chronic condition on medical aid?

Accepted Answer

Before the scheme pays for chronic medicine, your doctor must register your condition with the scheme, usually with a form or online. Without it, the medicine comes from your savings or your own pocket. In simple terms: You have to sign up for the chronic benefit before it starts working, like registering for a bus pass. Example: You're diagnosed with high blood pressure. Your GP sends a chronic application to your scheme. Once it's approved, your monthly tablets are paid from the chronic benefit instead of your savings.

Question 50

What is a medicine formulary?

Accepted Answer

A formulary is the scheme's list of approved medicines for each condition. Medicine on the list is covered in full; medicine not on it often has a co-payment. In simple terms: The scheme's list of approved medicine. Pick from the list and it's free; pick something else and you chip in. Example: On Bestmed Beat plans, chronic medicine that isn't on the formulary has a 30% co-payment in 2026. On Pace 4 it's only 10%.

Question 51

What is a Designated Service Provider (DSP)?

Accepted Answer

A DSP is a hospital, doctor, pharmacy or other provider the scheme has chosen for a benefit, often PMBs or chronic medicine. Using someone else can mean a co-payment. In simple terms: The scheme's preferred shop. Use it and you pay nothing; go elsewhere and you pay part. Example: On Bonitas BonCore, chronic medicine must come from Marara Pharmacy, the DSP. Using another pharmacy means a 30% co-payment in 2026.

Question 52

What is the difference between generic and brand-name medicine?

Accepted Answer

An originator is the original branded medicine. A generic has the same active ingredient and is usually much cheaper. Schemes often pay only up to the generic price, and you pay the difference if you choose the brand. In simple terms: Like store-brand cereal versus the famous brand: same ingredients, lower price. Example: Your brand-name cholesterol tablets cost R450 a month and the generic R180. If your scheme pays up to the generic price, choosing the brand costs you R270 a month.

Question 53

How does medical aid cover cancer treatment?

Accepted Answer

Cancer treatment is usually covered after you register on the scheme's cancer programme. Many plans cover a set amount per year, then pay a lower percentage. PMB cancer treatment is covered in full at the scheme's chosen providers. In simple terms: The scheme sets a budget for cancer treatment each year. After that, it still helps, but you pay a share. Example: Discovery Classic Priority covers the first R250,000 of cancer treatment over 12 months in 2026, then 80% of the Discovery Health Rate after that.

Question 54

Does medical aid cover biological or specialised medicine?

Accepted Answer

Biological and specialised medicines are expensive, often newer treatments, for example for cancer or rheumatoid arthritis. Many plans cover them only up to a separate limit, or only as PMBs. In simple terms: High-tech medicine that can cost more than a car each year, so plans set special rules. Example: Discovery Executive and Classic Comprehensive have a Specialised Medicine and Technology Benefit of up to R200,000 per person a year in 2026, with a co-payment of up to 20%.

Question 55

Does medical aid cover mental health?

Accepted Answer

Medical aid covers psychiatric hospital stays and therapy. PMBs include up to 21 days in hospital or 15 out-of-hospital sessions a year for certain conditions. Many plans add more. In simple terms: Your mind is part of your health too, and medical aid covers help for it. Example: Momentum Incentive covers up to R50,600 per person a year for in-hospital mental health care, including rehabilitation, in 2026.

Question 56

What does medical aid cover for pregnancy?

Accepted Answer

Maternity benefits cover pregnancy and birth: antenatal visits, scans, the delivery and the baby's early check-ups. Register on the scheme's maternity programme early to unlock everything. In simple terms: The scheme's welcome-baby package, from the first scan to the first check-up. Example: Momentum Extender in 2026: 12 antenatal visits, 2 pregnancy scans, a doula (up to R2,500), 3 nurse home visits and 2 paediatrician visits in the baby's first year.

Question 57

Does medical aid cover newborn intensive care?

Accepted Answer

Neonatal care is hospital care for a newborn baby, including intensive care. Most plans cover it in full; some entry-level plans set a limit. In simple terms: If a baby is born early or sick and needs the special baby ICU, this is what pays. Example: Discovery Active Smart limits neonatal care to R72,600 in 2026. On Momentum plans, neonatal intensive care has no annual limit.

Question 58

What is a trauma benefit?

Accepted Answer

A trauma benefit pays for day-to-day treatment after a serious event, such as a car accident, near-drowning or severe allergic reaction, from the scheme instead of your savings. In simple terms: After something really bad happens, the follow-up visits don't eat your pocket money. Example: Your child nearly drowns. On Momentum Incentive, the follow-up treatment that's part of the recovery is paid by the trauma benefit, not from your savings.

Question 59

What does "covered at 100% of the scheme rate" mean?

Accepted Answer

Every scheme has its own price list for medical services, called the scheme rate or tariff. A plan that pays "100% of the scheme rate" pays up to that price. Richer plans pay 200% or 300% of it. In simple terms: The scheme decides what a doctor's visit should cost. If the doctor charges more, someone has to pay the extra. Example: Say the scheme rate for an operation is R10,000 and the surgeon charges R20,000. A plan paying 100% pays R10,000 and you owe R10,000. A plan paying 200%, like Momentum Incentive, pays the full R20,000.

Question 60

What is a medical aid shortfall?

Accepted Answer

A shortfall is the difference when a doctor charges more than your medical aid pays. You're responsible for it, unless you have gap cover. In simple terms: The bill that arrives after the scheme has paid its part. Example: Your anaesthetist charges R8,000 and your plan pays R5,000. The R3,000 shortfall lands in your post box.

Question 61

What is a specialist with a payment arrangement?

Accepted Answer

A specialist with a payment arrangement has agreed to charge the scheme's agreed rate. They're usually paid in full, so there's no shortfall. In simple terms: Doctors who have a deal with your scheme. Use them and there's no surprise bill. Example: On Discovery and Momentum plans, specialists with a payment arrangement (Momentum calls them Associated specialists) are covered in full. Others are paid only up to the plan's percentage of the rate.

Question 62

What is a co-payment?

Accepted Answer

A co-payment is the part of a bill you pay yourself, even though you're covered. It can be a fixed amount or a percentage. In simple terms: Going halves with the scheme, except you usually pay the smaller half. Example: On Bonitas BonEssential, using a hospital outside the network for a planned admission means a 30% co-payment: on an R80,000 bill, that's R24,000.

Question 63

What is an annual limit and a sub-limit?

Accepted Answer

An annual limit is the most the scheme pays for a benefit in a year. A sub-limit is a smaller limit inside it. Once a limit is reached, you pay. In simple terms: Your yearly budget for something, with smaller budgets inside it. Example: Momentum Extender's optical limit is R5,500 per person a year, with a R3,000 sub-limit for frames. Spend R3,500 on frames and you pay the extra R500 yourself.

Question 64

What is gap cover, and do I need it?

Accepted Answer

Gap cover is a separate insurance policy, not medical aid, that pays shortfalls when a specialist in hospital charges more than your plan pays. Many policies also cover co-payments and upfront payments. In simple terms: A plaster for the gap between what the doctor charges and what the scheme pays. Example: You have surgery and get a R15,000 shortfall from the surgeon and a R5,500 co-payment. Gap cover pays both, for a small monthly premium.

Medical aid, explained simply.

2026 prices