Last reviewed: September 2026. We review our guides regularly to keep them accurate.
By Martin Janse van Rensburg, Sales Manager and Financial Advisor at Curemed. Reviewed by Roxanne Hurter-Ehlers, Director of People and Governance.
A medical aid co-payment is a fixed amount that a member pays towards a specific procedure, scan or hospital admission, over and above the monthly contribution. It arises because the rules of the plan say the scheme will not fund that event in full, usually because of the type of procedure or because the member chose a facility or doctor outside the network of the scheme. Medical aid co-payments in South Africa differ by scheme, by plan and by where the procedure is done, and a hospital will often ask for the amount upfront at admission.
In short
- A co-payment is a set amount towards one event. A deductible is the first portion of an account that the member pays before the scheme starts paying. Either can be asked for upfront at hospital admission.
- On Discovery Health Medical Scheme in 2026, a single scope carries a R4,650 co-payment in a network day clinic on the plans listed below, against R6,800 to R8,000 in hospital depending on the series.
- Bonitas BonPrime and Primary charge R2,020 per scope event. Bestmed charges R2,872 per scope event in an acute hospital and nothing in a network day hospital. Medihelp MedElite charges R2,730 per admission in a day procedure facility.
- Voluntary use of a hospital outside the network costs more: R12,680 on Bonitas BonStart and BonStart Plus, up to R15,025 on Bestmed Beat and Rhythm, and R12,875 for deviating from the day procedure network on Medihelp MedMove.
- Regulation 8 of the General Regulations to the Medical Schemes Act requires Prescribed Minimum Benefits to be paid in full without a co-payment, but permits one where a member voluntarily uses a provider other than the designated service provider.
How does a medical aid co-payment differ from a deductible and a self-payment gap?
The terms are used loosely, but they describe different mechanics. A co-payment is a set rand amount, or sometimes a percentage, that the rules of the scheme attach to a named event such as a scope, a scan or a joint replacement. The scheme pays the rest of the approved account.
A medical aid deductible works from the other end. The member pays the first portion of the account, and the scheme pays from that point onward. Medihelp MedMove is an example: the member pays the first R1,805 of every admission that is not a Prescribed Minimum Benefit, and a further 35 percent where treatment is not in the hospital network.
A self-payment gap is different again. It appears on plans with a medical savings account and a threshold benefit, where day-to-day claims fall to the member once savings run out and until the threshold is reached. We explain that structure in our guide to the self-payment gap on medical aid. This article deals with co-payments and deductibles on hospital and procedure events.
Why does the place of service drive the amount?
Schemes negotiate rates with networks of hospitals, day clinics and doctors. When a member uses those providers, the scheme knows what the account will be and can fund it in full or with a smaller co-payment. When a member goes outside the network by choice, the scheme recovers part of the difference through a larger co-payment.
The same logic applies to the type of facility. A scope done in a day clinic costs the scheme less than the same scope done in an acute hospital, and the co-payment schedule reflects that. In the rooms of a doctor the cost is lower still, and several schemes charge no co-payment at all in that setting.
This is why two members on the same plan, having the same procedure in the same month, can face very different upfront payments at hospital admission. The procedure did not change. The venue did.
What do medical aid co-payments look like at four schemes in 2026?
The table below sets out published 2026 figures from Discovery Health Medical Scheme, Bonitas, Bestmed and Medihelp. It covers those four schemes only and is not a complete list of the market. The figures come from the scheme documents named in the caption, and the registered rules of each scheme remain the final word.
| Scheme and plan | Event | Co-payment | Condition |
|---|---|---|---|
| Discovery Health, Executive Plan and Comprehensive Series | Single scope, day clinic | R4,650 | In the Day Surgery Network |
| Discovery Health, Executive Plan and Comprehensive Series | Single scope, hospital | R6,800 | Reduces to R5,450 with a doctor in the value-based network |
| Discovery Health, Priority Series | Single scope, day clinic | R4,650 | In the Day Surgery Network |
| Discovery Health, Priority Series | Single scope, hospital | R7,500 | Reduces to R6,050 with a doctor in the value-based network |
| Discovery Health, Saver, Smart Saver, Smart and Core Series | Single scope, day clinic | R4,650 | In the Day Surgery Network |
| Discovery Health, Saver, Smart Saver, Smart and Core Series | Single scope, hospital | R8,000 | Reduces to R6,650 with a doctor in the value-based network |
| Discovery Health, plans above | Gastroscopy and colonoscopy in one admission, day clinic | R5,700 | In hospital R8,400, R9,450 or R9,950 by series, each reducing with a value-based network doctor to R6,850, R7,650 or R8,250 |
| Discovery Health, plans above | Scope in the rooms of a doctor | No co-payment at a network provider | R1,800 for a single scope and R3,100 for a bidirectional scope at a provider outside the network |
| Bonitas BonPrime and Primary | Gastroscopy or colonoscopy | R2,020 per event | Per the 2026 brochures |
| Bonitas BonPrime | MRI or CT scan | R2,240 per scan event | Not where the scan is a Prescribed Minimum Benefit |
| Bonitas Standard and Standard Select | MRI or CT scan | R1,860 per scan event | Not where the scan is a Prescribed Minimum Benefit |
| Bestmed | Colonoscopy or gastroscopy | No co-payment in a network day hospital | R2,872 per event in an acute hospital that is not a day hospital |
| Medihelp MedElite | Gastroscopy or colonoscopy in a day procedure facility | R2,730 per admission | No co-payment in the rooms of a doctor |
| Medihelp MedElite | MRI or CT scan | Member pays the first R1,500 per examination | Within a family limit of R40,000 a year |
| Medihelp MedMove | Any admission that is not a Prescribed Minimum Benefit | Member pays the first R1,805 per admission | Plus a further 35 percent where treatment is not in the hospital network |
| Medihelp MedMove | MRI or CT scan | Member pays the first R2,850 per examination | Per the 2026 plan page |
Two patterns stand out. First, where a scheme publishes both a day clinic and a hospital amount for the same procedure, the day clinic amount is lower. Second, a scope done in the rooms of a network doctor carries no co-payment on the Discovery Health plans listed and on Medihelp MedElite.
The Discovery Health cover for diagnostic endoscopies 2026 document also lists cases where no scope co-payment applies at all: where the scope forms part of a confirmed Prescribed Minimum Benefit, where it is indicated and approved for dyspepsia, where the patient is aged 12 or younger, and for in-rooms scopes at a network provider. On KeyCare plans, scopes are covered only for children aged 12 and younger, scopes related to surgery, or where covered as a Prescribed Minimum Benefit, and must be done in the KeyCare Day Surgery Network. Scopes in hospital are not covered on KeyCare.
| Scheme and plan | Situation | Co-payment |
|---|---|---|
| Discovery Health, Classic Comprehensive | Scope outside the Day Surgery Network | R7,250, rising to R8,400 where both scopes are done |
| Discovery Health, Classic Smart Comprehensive | Scope outside the Day Surgery Network | R12,650 |
| Discovery Health, Priority | Scope outside the network | R7,250 in a day clinic, R7,500 in a hospital, R9,450 where both scopes are done |
| Discovery Health, Saver and Core | Scope outside the network | R7,250 in a day clinic, R8,000 in a hospital, R9,950 where both scopes are done. Delta options R11,100 |
| Discovery Health, Smart Saver | Scope outside the Smart Day Surgery Network | R12,650 |
| Discovery Health, Smart Series | Scope outside the network | R12,650 on Classic and Essential, R14,750 on Essential Dynamic and Active Smart |
| Bonitas BonPrime | Day surgery outside the network | R7,100 |
| Bonitas BonPrime | Hospital outside the network | 30 percent co-payment |
| Bonitas BonPrime | Cataract surgery outside the designated service provider | R8,400 |
| Bonitas Primary | Day surgery in a day hospital outside the network | R6,500 |
| Bonitas BonStart and BonStart Plus | Hospital outside the network | R12,680 |
| Bestmed Beat and Rhythm network options | Voluntary use of a hospital outside the network | Up to R15,025 |
| Medihelp MedMove | Deviation from the day procedure network | R12,875 per admission |
What does one household example show?
Take a family on a Discovery Health Saver Series plan in 2026 where one parent needs a single diagnostic scope. Done in the rooms of a network gastroenterologist, the co-payment is nil. Done in a day clinic in the Day Surgery Network, it is R4,650.
If the family chooses an acute hospital, the co-payment rises to R8,000, or R6,650 if the doctor is in the value-based network of the Scheme. If they choose a day clinic outside the network, it is R7,250. Every one of those amounts comes from the same plan in the same year. The venue, and the network status of the doctor, decide what the household pays.
What does Regulation 8 say about co-payments on Prescribed Minimum Benefits?
The rules sit in the General Regulations to the Medical Schemes Act 131 of 1998, published under Government Notice R.1262 in Government Gazette 20556 of 20 October 1999, as amended. Regulation 8(1) says a benefit option must pay in full, without co-payment or the use of deductibles, the diagnosis, treatment and care costs of Prescribed Minimum Benefit conditions. In ordinary words, if your condition and treatment fall within the Prescribed Minimum Benefits, the scheme must pay for them.
That protection has a condition attached. Regulation 8(2)(a) allows the rules of a scheme to say that full payment applies only where the service is obtained from a designated service provider. Regulation 8(2)(b) then allows a co-payment or deductible, in an amount set out in the rules of the scheme, where a member or dependant voluntarily uses a provider other than the designated service provider. So a Prescribed Minimum Benefit can carry a co-payment, but only where the member chose to go elsewhere.
Regulation 8(3) protects members who had no real choice. A member is deemed to have used a non-designated provider involuntarily in three situations: where the service was not available from the designated service provider or would not be provided without unreasonable delay, where immediate treatment was required in circumstances or at locations that reasonably precluded use of a designated service provider, and where there was no designated service provider within reasonable proximity to the ordinary place of business or personal residence of the member. In those cases no co-payment is payable.
Two further points matter at the admissions desk. Regulation 8(5) allows a co-payment where a member knowingly declines a clinically appropriate drug on the formulary of the scheme. Regulation 8(6) says a scheme may not require pre-authorisation before emergency treatment. The Council for Medical Schemes publishes guidance on Prescribed Minimum Benefits.
What steps can a member take before admission?
One action matters more than any other: ask where the procedure will be done and whether that facility and doctor are in the network of your plan. If the answer is a hospital and a day clinic would do, ask your doctor whether the day clinic is clinically appropriate. If the scope can be done in the rooms, ask about that too.
Then confirm the co-payment in writing with the scheme during pre-authorisation, not at the admissions desk. Ask whether the procedure is being treated as a Prescribed Minimum Benefit. If you are being sent outside the network for one of the reasons in Regulation 8(3), say so and ask the scheme to record it.
Check whether you hold Gap Cover and what it says about co-payments. In an emergency, the Discovery Health document confirms that no out of network penalty applies, and the Regulations say no pre-authorisation may be demanded first. Get treated, then notify the scheme.
Does Gap Cover pay a medical aid co-payment?
Often, yes, but it depends on the policy. Gap Cover is short term insurance regulated under the Demarcation Regulations, published as Government Notice R.1582 in Government Gazette 40515 of 23 December 2016 and effective from 1 April 2017, under section 70 of the Short-term Insurance Act 53 of 1998. It is not a medical scheme and does not replace one.
A Category 1 medical expense shortfall contract covers the difference between the cost of a relevant health service and the amount the medical scheme paid. Many policies extend this to co-payments and deductibles imposed by the rules of the scheme, including the fixed amounts in the tables above. The base annual aggregate limit in the Regulations is R150,000 per insured person per year, and that base escalates annually with inflation under Regulation 7.2(2).
What is covered, and any limits, exclusions and waiting periods, differ from one policy to another. Read the wording of your own policy before you rely on it. Our complete guide to Gap Cover in South Africa sets out how the products are structured.
How should co-payments feature in a plan comparison?
Contribution is the number everyone compares first, but a co-payment schedule can matter as much for a household that expects a procedure. Two plans with similar contributions can differ materially on a single scope, a scan or an admission outside the network. A network restriction is not a problem if the network hospitals are close to where you live and work, and a real problem if they are not.
When you compare options, look at the co-payment on scopes, on MRI and CT scans, on day surgery outside the network and on hospital admission outside the network, and look at where the network facilities are. Our medical aid comparison page sets plans out side by side, and our guide on how to choose a medical aid in South Africa walks through the trade-offs.
A Curemed Advisor can do this work with you. Curemed is an FSCA-licensed brokerage, FSP 44098, and our Advisors help members across the country compare plans and arrange Gap Cover at no cost to the member. If you have been told at admission that money is owed upfront, an Advisor can also help you check whether the amount matches the rules of your plan.
What else do members ask about co-payments?
Can a medical aid co-payment be claimed back from tax?
Not as a direct refund, but a qualifying medical expense that you paid yourself and that the scheme did not reimburse may count towards the additional medical expenses tax credit when you file your return. The credit belongs to the taxpayer who actually paid the expense, which is not always the person named as the main member on the scheme. Keep the hospital invoice and proof of payment in your own name, and confirm the treatment with a registered tax practitioner.
What happens if I cannot pay the upfront amount on the day?
Speak to the admissions office before you sign anything. Ask whether the hospital will accept a payment arrangement, and ask your doctor whether the procedure can be moved to a network day clinic or to the rooms, where the co-payment may fall away. If the admission is an emergency, tell the hospital, since a scheme may not require pre-authorisation before emergency treatment and no co-payment is payable on a Prescribed Minimum Benefit obtained involuntarily. Gap Cover usually reimburses the member after the event, so it helps with the cost but does not always remove the need to pay on the day.
If I change plans during the year, does my co-payment change?
The co-payment that applies is the one in the rules of the plan you are on at the date of admission. Schemes generally allow a plan change once a year, with the new plan starting at the beginning of the next benefit year, so a change cannot be used to reduce a co-payment on a procedure already scheduled for this year. Check the co-payment schedule of any plan you are considering before you switch.
Is a co-payment deducted from my medical savings account?
It depends on the rules of the scheme and the type of co-payment. Some schemes allow certain co-payments to be settled from available savings, while others require the member to pay the facility directly and keep savings for day-to-day claims. Ask the scheme during pre-authorisation how the co-payment will be collected, and remember that using savings for a co-payment leaves less for other claims later in the year.
Who do I approach if a co-payment looks wrong?
Start with the scheme itself, and ask for the rule the co-payment is based on and the reason it was applied. If you believe the treatment was a Prescribed Minimum Benefit, or that you used a provider outside the network for one of the reasons in Regulation 8(3), say so in writing. If the scheme does not resolve it, you can lodge a complaint with the Council for Medical Schemes. A Curemed Advisor can help you gather the documents and put the query to the scheme.
Martin Janse van Rensburg
Sales Manager and Financial Advisor | Curemed Health and Wealth Consultants
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