How to apply for Medical Aid in South Africa

Choosing the right Medical Aid can feel like a lot to take in, but the process itself is straightforward once you know what's expected. This guide walks through who qualifies, what documents you'll need and why you should consider comparing multiple Medical Aid plans before you commit to one.

Hippo's quick bites:

1. You can apply for Medical Aid in South Africa if you're:

   1. 18 years of age or older

   2. Hold a valid SA ID or passport

   3. Can afford the monthly contribution or proof of income for capitated plans

2. Schemes can't turn you away for your health status, the only caveat to this is that waiting periods and late joiner penalities may apply.

What is a medical scheme and how does it work?

A Medical Aid scheme is a not-for-profit body that pools members' monthly contributions to cover medical expenses. It offers South Africans the ability to access quality healthcare. And, depending on your plan, Medical Aid's can offer anything from unlimited private or network hospital cover, specific out of hospital procedures and day-to-day cover for general healthcare practitioners and medication.

Who regulates medical schemes in South Africa?

In South Africa, every medical scheme is registered with, and regulated by, the Council for Medical Schemes (CMS). The CMS oversees all registered schemes operating in the country, and sets minimum standards, including Prescribed Minimum Benefits (PMBs) that every scheme must provide in qualifying circumstances.

Who qualifies to apply for a new Medical Aid plan

• You need to be 18 or older to join as the main member.

• A valid South African ID, passport or work permit is required.

• Proof of income is needed if you choose an income-banded option.

Note: Schemes cannot reject you based on your health, though waiting periods or a late-joiner penalty can apply if you're over 35 and have no previous Medical Aid cover.

Steps to apply for Medical Aid

1. Decide what cover you actually need, from hospital-only cover to day-to-day benefits.

2. Compare multiple Medical Aid plans on price and benefits.

3. Gather your documents, including ID, banking details and proof of income.

4. Submit your application, either online or through an adviser.

5. Receive your quote, then wait for confirmation once you're accepted.

Documents you need for your Medical Aid scheme application

• Personal details: full name, ID number, date of birth and contact details.

• Banking details and a recent bank statement for your debit order.

• Previous Medical Cover certificates, to avoid unnecessary waiting periods.

• Health records, including any chronic conditions or planned treatment.

A few helpful things to consider:

1. If you're adding dependants to your application:

If you're adding a spouse or children, you'll need the same personal details for each, along with marriage or birth certificates.

2. When considering an income-banded, or capitated plan:

Income-banded plans set your contribution according to what you earn. A recent payslip or tax certificate is usually enough to confirm this.

3. How a medical savings account can help you save:

Many Medical Aid plans include a savings account for day-to-day expenses like GP visits and medicine. Unused funds can often roll over, giving you more control over out of hospital procedures and costs.

4. Getting the most our of your network option:

Most plans work with a network of healthcare providers. Using providers within your network typically keeps your out-of-pocket costs lower.

5. Always declare your health information:

Be upfront about existing conditions and medication. Non-disclosure can delay claims or, in serious cases, lead to your membership being cancelled.

6. Switching Medical Aid schemes and plans:

South Africans can switch Medical Aid schemes at any point during the year. However, most medical schemes ask for one calendar month's notice in writing.

Moving to a different plan within your current scheme works differently. This kind of change is usually restricted to the final quarter of the year, with the change taking effect on 1 January.

Understanding waiting periods on a new Medical Aid plan

• A general waiting period of up to three months can apply to new members.

• A condition-specific waiting period of up to twelve months may apply to pre-existing conditions.

• These periods exist to prevent people joining only once they need care.

Common mistakes to avoid when you apply for Medical Aid

• Leaving out health information to try and lower your premium

• Missing debit order dates, which can suspend your cover

• Not checking whether your regular doctor is in-network

• Assuming all plans offer the same benefits at the same price

Types of cover under a Medical Aid plan

Affordable Medical Aid options for every budget

Contributions vary widely by scheme and plan, so there's usually affordable options available to fit different lifestyles and budgets. Momentum Medical Scheme, for example, offers income-based plans from R645 a month, while Medihelp's student plan starts from R804 a month, aimed at younger members with smaller budgets. At the other end, comprehensive plans from schemes like Fedhealth and Discovery Health can run up to around R19,000 and R12,300 a month respectively for extensive cover.

A snapshot of medical schemes in South Africa

Comparing Medical Aid plans before you choose

Premiums, benefits and savings account structures can differ significantly between schemes, even for similar-sounding plans. Comparing a few quotes side by side is the simplest way to see what you're actually getting for your money, helping you make an informed decision.

Get your Medical Aid quotes through Hippo

Hippo has spent years helping South Africans compare cover, and has been recognised with industry awards along the way. We compare quotes from 10 of South Africa's leading Medical Aid schemes, so you can weigh up hospital cover, savings accounts and monthly contributions in one place.

Once you've chosen a plan, a Hippo Advisory Services representative will be in touch to help you complete your application.

Compare Medical Aid quotes and save!

Frequently asked questions

Can I apply for Medical Aid if I have a pre-existing condition?

Yes. Schemes cannot refuse membership based on your health, though a waiting period or condition-specific exclusion may apply.

How long does the application process take?

Processing usually takes a few days once your documents and application are submitted in full.

Can students apply for Medical Aid?

Yes, several schemes offer student-focused plans at a lower monthly rate.

Do Medical Aid premiums differ by age?

Premiums can vary by age, income and the plan you choose, so consider comparing and weighing your options before you apply.

What happens after I submit my application?

The scheme reviews your documents and health declaration, then confirms your benefits, contribution and any applicable waiting periods.

This article is for informational purposes only and does not constitute financial, legal, medical or insurance advice. Hippo is a comparison site helping you evaluate quotes from trusted South African insurers. Always review policy details before making changes. Quotes are risk profile dependent and subject to annual review. No fees are charged for using Hippo’s comparison service. HAS (Pty) Ltd and HCS (Pty) Ltd are authorised FSPs. Terms and conditions apply.