Kaelo medical aid: what Kaelo Health, Kaelo Gap and Prime Cure are

Kaelo's compliance page says: "This is not a Medical Scheme and the cover is not the same as that of a Medical Scheme. This Policy is not a substitute for Medical Scheme membership." Kaelo Risk (Pty) Ltd is an authorised financial services provider and holds preference shares in Centriq.

The site is aimed at companies: it has a "request a presentation" form for employee groups and no public price list. Retail prices live on the Dis-Chem Health site, so read our Dis-Chem medical aid page for the MyHealth plans.

• Kaelo is a healthcare and financial-solutions group and insurance administrator, not a medical scheme. Its Kaelo Health day-to-day and accident products and Kaelo Gap are insurance insured by Centriq Insurance Company Limited (FSP 3417); Western Gap is underwritten by Western National Insurance (FSP 9465); Old Mutual Gap is administered by Kaelo and underwritten by GENRIC (FSP 43638). Kaelo also administers Dis-Chem Health. (kaelo.co.za)
• Kaelo administers Dis-Chem Health (retail medical insurance, accident and gap cover). (dischemhealth.co.za)
• Kaelo lists Old Mutual Gap, iWYZE Gap and ConnectGap among its products; Old Mutual Gap is administered by Kaelo and underwritten by GENRIC. (kaelo.co.za)
• Kaelo's own FAQ explains health insurance is exempt from the Medical Schemes Act and does not have to cover Prescribed Minimum Benefits. (kaelo.co.za)
• Kaelo Health Accident Cover does not cover planned hospital admissions or treatment after discharge. (kaelo.co.za)
• Kaelo Health is marketed to employers with tax-efficient direct provider payments; individuals cannot claim tax benefits on insurance premiums. (kaelo.co.za)
• Kaelo Health cover is limited to South Africa. (kaelo.co.za)
• Kaelo Health premiums are rated annually with adjustments on 1 January, with the right to adjust on 31 days' notice. (kaelo.co.za)
• Kaelo Gap and Old Mutual Gap claims are paid in 7-14 working days once all documents are received. (kaelo.co.za)
• Old Mutual Gap has a three-month general waiting period and a twelve-month condition-specific waiting period. (kaelo.co.za)
• Kaelo's Better Rewards with Dis-Chem gives a 20% discount on a basket of products, with optional 5% Pharmacy and 5% Capitec boosts, as part of Lifestyle Benefits at an additional fee. (kaelo.co.za)

Kaelo (Kaelo Health, Kaelo Gap, Prime Cure, Dis-Chem Health administrator) publishes 9 products for 2026. Prices are the monthly contribution for a main member as published by Kaelo. Adult and child dependants pay extra. Checked on 29 September 2026.

Sources: kaelo.co.za/kaelo-health, kaelo.co.za/kaelo-gap, kaelo.co.za/products, oldmutual.co.za/...l/solutions/health/gap-cover, kaelo.co.za.

Kaelo Health benefits are not described on the page we checked, and the retail versions of MyHealth Core and Plus are sold as Dis-Chem MyHealth. No Kaelo-branded price is published, so ask your employer or broker for a quote.

Checked on 29 September 2026 against Kaelo's official website. Numbers change, so confirm on the linked page before you call. A scheme will not ask you to pay into a new bank account over the phone: hang up and call the official number if anything feels off.

Sources: kaelo.co.za/contact. All schemes' numbers are on our medical aid contact numbers page.

Kaelo's own FAQ is direct about the limits.

• No general hospital cover for illness. Accident Cover has a set limit for emergency hospitalisation, stabilisation and illness (the Dis-Chem version limits illness to 12 named emergency conditions), and it will not cover the cost of a planned hospital admission or treatment after discharge.
• No PMBs. Health insurance does not have to include cover for Prescribed Minimum Benefits. Read the PMB guide.
• South Africa only. International cover is not provided.
• No tax credit for individuals. Insurance products carry no tax benefit for the individual taxpayer, unlike medical scheme contributions. See the medical aid tax credit guide. Kaelo markets a tax-efficient direct provider payment arrangement to employers.

Day-to-day cover runs through the Prime Cure network, which Kaelo owns wholly and which has more than 9,500 healthcare service providers. The Kaelo MyHealth app holds your digital membership card, policy and benefits, and offers virtual consultations.

Gap cover is short-term insurance that pays tariff shortfalls, co-payments, sub-limits and oncology shortfalls for members of a medical scheme. It is not medical aid and it is not a hospital plan. Kaelo says claims take 7 to 14 working days to finalise once all the required documents are received.

Old Mutual Gap, administered by Kaelo, has a three-month general waiting period and a twelve-month condition-specific waiting period. Old Mutual Gap is also distributed by Old Mutual Life Assurance Company (South Africa) Limited: see Sanlam and Old Mutual medical aid. Read the gap cover guide and the gap cover buying checklist before you buy.

It can suit an employer that wants a low-cost primary care and accident benefit for staff who cannot afford a scheme, or a scheme member who wants gap cover.

It does not suit an individual expecting a full medical aid. Kaelo Health does not pay for general illness in hospital, so it should not be your only cover.

Scheme alternatives. From the 2026 figures: Bonitas BonCore at R1 275 for every beneficiary, Fedhealth flexiFED Savvy hospital plan at R1 155 for the main member, and income-based Discovery KeyCare Start and Momentum Ingwe. See hospital plans in South Africa and medical aid versus health insurance.

Whether you meet Kaelo through an employer, a broker or the Dis-Chem Health site, ask these in writing:

• Who is the insurer, and is the product health insurance, gap cover or an accident-only benefit?
• Is there any hospital cover for illness, and which named emergency conditions, if any, are included?
• What are the waiting periods? Kaelo's FAQ says new day-to-day policies carry a one-month general waiting period, with a six-month wait for chronic medication for HIV, type 2 diabetes and dentures.
• Is your doctor, pharmacy or dentist on the Prime Cure network?
• Which chronic conditions are on the list, and what are the annual limits?
• How and when are premiums reviewed? Kaelo can adjust on 31 days' notice.

Then compare the answers with a registered scheme's hospital plan, which pays PMB conditions in full. The questions to ask before joining a scheme checklist works for both.

Kaelo lists 2026 brochures for MyHealth Vital, Core and Plus, and for Core and Optima gap. It says its products are rated annually, with adjustments taking effect on 1 January and the right to adjust on 31 days' notice. We found no announced 2026 or 2027 increase.

Complaints go to Kaelo first: use the contact table, and the escalations email on the Dis-Chem Health site for that brand. If it is not resolved, complaints about insurance go to the National Financial Ombud, not the Council for Medical Schemes.