Medical aid for families in South Africa: plans, child rates and costs for 2026

Every scheme sets a contribution for the main member, another for each adult dependant, and a lower one for each child. The plan is community rated, which means the Medical Schemes Act allows contributions to be based on income or the number of dependants, but not on age, sex or state of health.

Many schemes also cap the number of children you pay for. Medihelp's savings plans charge for only two children under 18. KeyHealth's Equilibrium and Silver plans charge for a maximum of three children. Profmed charges for up to three child dependants on ProSecure, ProSecure Plus and ProPinnacle. On Fedhealth's published rate tables the fourth and later child is free.

Always add up the whole family, not just the main member price. Two plans with the same main member rate can differ by hundreds of rand once a spouse and children are added.

These are open-scheme plans that suit families, priced per month for 2026. All figures come from each scheme's own published rates. Discovery Health also has young-family Smart Saver plans, Classic Smart Saver at R3 350 for the main member and Essential Smart Saver at R2 750, but its child rates are shown on a personal quote.

Worked example, using Bonitas BonEssential Select for two adults and two children: R2 345 + R1 718 + R774 + R774 a month. Do the same sum for each plan you are considering. The Bonitas, Fedhealth and Medihelp pages show how each plan range is built.

Hospital or network hospital plan. Suits a healthy young family that wants protection against big bills at the lowest premium. You pay GP visits and medicine yourselves. Watch the network rules: Bestmed's Beat1 Network charges a R15 025 co-payment if you use a non-network hospital voluntarily, and Bonitas's BonEssential Select is a network plan too. See hospital plans compared with comprehensive plans.

Network plan with day-to-day cover. Plans such as Fedhealth's sureFED Essential and Medshield's MediValue add fixed day-to-day limits for GP visits and medicine at a moderate price, in return for using a defined hospital network.

Savings plan. Part of your contribution goes into a medical savings account that pays everyday bills. It works well if you spend most of what goes in. See how a medical savings account works.

Comprehensive plan. Broadest cover and the highest price. It only pays off for families with regular specialist, dental or chronic needs.

For the difference between network and traditional plans, read network vs traditional plans.

Children use a lot of day-to-day care in a year: GP visits for coughs and ear infections, antibiotics, dentistry and eye tests. A savings account can run out in the middle of the year, and after that you pay from your own pocket until the year resets.

Before you choose, add up what your family spent on GPs, medicine and dentists over the last 12 months. Then compare it with the savings allocation and day-to-day limits on each plan. Some plans pay a set number of GP visits from risk cover, which protects your savings. Read day-to-day benefits explained for the questions to ask.

The Medical Schemes Act says a scheme may not impose a waiting period on a child born while you are a member. Tell the scheme promptly and send the birth details. Many schemes set a deadline for adding a newborn, often 30 days, so check your rules. Add the baby late and you risk gaps in cover and rejected claims.

Other new family members are different. If a spouse or older child joins without cover in the last 90 days, the scheme may impose up to 3 months of general waiting period and up to 12 months for conditions, which are maximums. Someone who moves from another scheme after a gap of under 90 days faces only one of the two, and neither applies to treatment that counts as a prescribed minimum benefit.

Planning a baby? The pregnancy and maternity guide explains how timing changes what is covered. For the full rules see waiting periods and exclusions.

Age limits for children differ by scheme. Fedhealth charges child rates up to age 27. Medihelp's MedReach, MedElite and MedPlus charge child rates until 26. Profmed charges adult rates from age 21, with child rates to age 28 for dependent students, if you send proof every year.

Conditions on the chronic disease list, such as childhood asthma, are prescribed minimum benefits. Every plan must pay for their diagnosis, treatment and care in full, but the scheme can require you to use its designated service provider and formulary. Register the condition with the scheme so the medicine is paid from the right benefit. Using a provider outside the network by choice can attract a co-payment. Read chronic disease benefits for how registration works.

For the 2026/27 tax year SARS gives a fixed monthly credit against your income tax: R376 for you, R376 for the first dependant and R254 for each additional dependant. For two adults and two children that is R376 + R376 + R254 + R254 a month. The credit does not depend on the size of your premium.

It is non-refundable and can only reduce the tax you owe. If the family's tax is small, part of it may go unused, and unused credit cannot be carried over. You may also claim an additional credit for scheme fees and out-of-pocket medical costs, but the rules are stricter for taxpayers under 65. The medical aid tax credit guide has the detail, and SARS explains the medical scheme fees tax credit on its own site.

Contributions rise every year. For 2027 the Council for Medical Schemes has recommended that increases be anchored at 3.8%, but that is a benchmark and not a cap. Fedhealth has announced 0% for 2027 on its two new sureFED plans, and Medshield has announced a 7.9% weighted average. Discovery, Bonitas and others usually announce later in the year. See medical aid increases for 2027.

Gap cover pays specialist shortfalls above scheme rates. It is a health insurance product, not medical aid, and complaints about it go to the National Financial Ombud. See gap cover explained.

If your scheme does not resolve a complaint, escalate to the Council for Medical Schemes on 0861 123 267 or [email protected], after you have used the scheme's own complaints process. The steps are on the CMS complaints procedure page.