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Medical aid, explained
The words you'll see on every plan, in plain English, and where our numbers come from.
Words you'll see
PMB
A list of about 270 conditions and 26 chronic illnesses that every medical scheme must cover in full, regardless of your plan. Emergencies are included.
If you're in a car accident, your scheme must pay for stabilising you even on the cheapest plan.
Scheme rate
The price the scheme has decided a procedure is worth. Doctors can charge more than this; the gap is yours to pay unless the plan covers a higher rate.
A plan at 100% scheme rate pays R1 000 for a consultation that costs R1 500 — you pay R500.
Co-payment
A fixed amount you pay yourself before the scheme pays the rest, usually for specific procedures or for using a hospital outside the network.
R5 000 co-payment on MRI scans means you pay the first R5 000 of every scan.
Medical Savings Account
A portion of your monthly contribution set aside for day-to-day expenses like GP visits and medicine. Once it's finished, you pay out of pocket until the next year.
On a 25% savings plan paying R4 000 a month, about R12 000 a year goes into savings.
Above Threshold Benefit
Extra day-to-day cover that only starts after you've spent a set amount yourself. Found on comprehensive plans.
After your savings and a self-payment gap, the scheme starts paying again.
Self-payment gap
The period after your savings run out and before above-threshold cover begins, when you pay everything yourself.
Designated Service Provider
A hospital, doctor or pharmacy the scheme has a deal with. Using them means no co-payment; going elsewhere often means paying a penalty.
Your plan's DSP for chronic medicine might be a specific pharmacy chain.
Chronic Disease List
The 26 long-term conditions (like diabetes, asthma, hypertension) whose medicine every scheme must cover.
Late-joiner penalty
A permanent surcharge on your contribution if you join a medical scheme for the first time after age 35.
Joining at 45 with no previous cover can add 25% to your contribution for life.
Waiting period
A period after joining when the scheme won't pay for some things: up to 3 months for everything, up to 12 months for conditions you already had.
Where the numbers come from
From brochure to this page
Each week during the open-enrolment season, and monthly the rest of the year, we visit every scheme's website and download the official benefit brochures for the coming year. Software reads each brochure into a standard format, so every plan can be compared on the same terms: what you pay per month, what is covered, the limits, and the surprises.
How figures are checked
Nothing goes live just because it was read. A plan is held back for a person to check when:
- a price we read doesn't appear in the brochure itself,
- the software was unsure of what it read,
- a price moved by more than 20% against what we already show, or
- the brochure is a scanned image rather than text.
Until it is checked, we keep showing the last confirmed figures. Every plan page links to the brochure it came from.
What this site is not
This is information, not financial advice. We don't recommend plans, take commission, or rank plans by anything other than what you choose to sort by. Medical schemes' rules and brochures always take precedence. Before you join or change plans, confirm the details with the scheme or an accredited financial adviser.
Hospitals near you and your location
If you choose “Use my location”, your browser shares your position with this page only. Distances are worked out on your device: your location is never sent to us or anyone else, and it isn't stored. You can always type a town instead.
Hospital locations come from OpenStreetMap contributors and are published under the Open Database License. We leave out entries that aren't hospitals and mark day and specialist hospitals, but the list may still be incomplete. Which plans cover a hospital comes from each plan's network rules in its brochure; for network plans, confirm the hospital with the scheme.
Use the data
All plan data is free to use as JSON: /data/index.json lists the years available, and /data/plans/<year>.json holds every plan for that year. Hospital locations are at /data/hospitals.json (ODbL).
Care Cart shows information from medical schemes' published brochures. It is not financial advice and does not recommend a plan. Confirm details with the scheme or an accredited adviser before you join. Open data (JSON) · Privacy · Terms.