Medical aid guides & help
The medical aid rules that catch people out - waiting periods, prescribed minimum benefits, co-payments, gap cover and tax credits - explained in plain language. These guides help you join, claim and get the most from your plan.
How it works
How does medical aid work in South Africa?
How does medical aid work in South Africa? What a medical scheme is, where your contribution goes, plan types, PMBs, waiting periods and 2026 figures.
Hospital plans explained: what a hospital plan covers and does not cover
A hospital plan is a medical scheme option that pays for hospital admission, surgery and PMBs but little day-to-day cover. What is in and out, explained.
How to join a medical aid in South Africa: steps, documents and what to expect
How to join a medical aid in South Africa: who can join, documents, the application steps, waiting periods, the late joiner penalty and what it costs in 2026.
How to change or cancel your medical aid without losing cover
How to change medical aid in South Africa: plan vs scheme, the 90-day rule explained correctly, notice, proof of cover and when to switch before 2027.
NHI and your medical aid in 2026: where things stand and what to do
The NHI Act is signed but no section has started. What it says about medical schemes, the Constitutional Court case, and what members should do now.
Medical aid tax credit 2026/27: amounts, extra credit and worked examples
Medical aid tax credit 2026/27: R376 a month for you, R752 for two people, R254 per extra dependant, plus the additional credit rules and how to claim.
Medical savings account (MSA) explained
Medical savings account explained: what an MSA pays for, real 2026 savings percentages by plan, the self-payment gap and what happens to unused savings.
Designated service providers (DSP) explained
Designated service providers explained: what a DSP is, why using one keeps PMBs paid in full, the co-payment for a non-DSP and when you can go elsewhere.
What happens if you cannot pay your medical aid, and what to do first
Cannot pay your medical aid? What usually happens when you miss a payment, why a downgrade beats cancelling, and cheaper options that protect your cover.
Benefits & claims
Prescribed Minimum Benefits (PMBs) explained
Prescribed minimum benefits explained: the 271 conditions, chronic list and emergencies every scheme must pay in full, DSP rules and the 2026 review.
Council for Medical Schemes: how to complain, step by step
How to complain to the Council for Medical Schemes (CMS): the steps, timelines, contact details as published, and when the National Financial Ombud applies.
Gap cover explained: what it pays, what it costs and what to check
Gap cover pays the shortfall between a specialist's bill and your medical aid, up to R226 881.03 a year in 2026. Prices, multiples and waiting periods.
What does medical aid cover in South Africa?
What does medical aid cover? Psychologist, braces, dentistry, glasses and frail care: what the PMB rules guarantee and what your plan must state.
Medical aid waiting periods and exclusions: what the law allows
Medical aid waiting periods in SA: the 3-month and 12-month limits, when a scheme can apply none, pregnancy, PMBs and what exclusions really mean.
Chronic disease benefits (CDL) explained
Chronic disease benefits explained: the Chronic Disease List conditions, how to register, formulary and DSP pharmacy rules, and getting medicine paid in full.
The medical aid late joiner penalty: bands, formula and a worked example
Late joiner penalty on medical aid: who it applies to at 35 or older, the 5% to 75% penalty bands, how your band is worked out and a Rand example.
Day-to-day benefits explained
Day-to-day medical aid benefits in South Africa: what they cover, how savings, thresholds and fixed limits fund them, real 2026 plan examples and tips.
How to claim from your medical aid
How to claim from medical aid in South Africa: direct claims vs paying upfront, submitting through the app, pre-authorisation, rejected claims and disputes.
Co-payments and sub-limits on medical aid: what you pay and how to avoid surprise bills
Medical aid co-payments and sub-limits in SA: what they are, when PMBs are exempt, the DSP rule, a Rand example and how gap cover helps in 2026.
Medical aid pre-authorisation explained
Medical aid pre-authorisation explained: what needs approval, how to get an authorisation number, emergency rules under the Regulations and penalties.
Emergency and ambulance cover explained
Emergency and ambulance cover on medical aid: why emergencies are PMBs, which ambulance provider each big scheme uses, numbers to save and what to do.
By life stage
Medical aid for young singles: the best-value plans in 2026
Medical aid for young singles in 2026: cheap hospital and network plans with verified prices, gap cover, waiting periods and why early cover avoids a penalty.
Medical aid for the self-employed and freelancers in South Africa (2026)
Medical aid for self-employed people in 2026: joining without an employer, plans for irregular income with prices, the tax credit and avoiding a lapse.