South African Health Cover Guide
Three very different products. Understanding the difference could save you thousands — or leave you exposed when you need cover most. This guide breaks down how they work, what the law says, and which is right for your situation.
| Feature | Hospital Plan | Medical AidMost comprehensive | Medical Insurance |
|---|---|---|---|
| Regulated by | CMS | CMS | FSCA |
| Must cover PMBs | ✓ Yes | ✓ Yes | ✗ No |
| Day-to-day cover | ✗ No | ✓ Yes | ⚠ Limited |
| Can refuse applicants | ✓ Yes | ✓ Yes | ✗ No |
| Risk-based premiums | ✓ Yes | ✓ Yes | ✗ No |
| Typical monthly (single) | R1,000–R3,000 | R1,200–R6,000+ | R300–R900 |
| Pays hospital directly | ✓ Yes | ✓ Yes | ⚠ Limited |
| Non-profit organisation | ✓ Yes | ✓ Yes | ✗ No |
Important: Hospital plans and comprehensive medical aid are both governed by the same law and the same regulator — the Medical Schemes Act 131 of 1998 and the Council for Medical Schemes. The only difference is how much they cover, not how safe or regulated they are.
Answer four questions — your recommendation updates as you go.
1. How often do you visit a doctor or clinic?
2. Do you have children or dependants on your cover?
3. What is your monthly budget for health cover?
4. How important is covering routine GP visits and prescriptions?
Costs vary significantly by scheme, benefit option, age, and number of dependants. These are indicative ranges for a single adult. Get a personalised quote to see exact pricing.
Hippo compares medical aid and hospital plans from Discovery, Bonitas, Momentum, Medihelp, and others.
Calcura is independent. We don't earn a commission from these links. Medical insurance products are not listed here as direct comparison requires individual underwriting.
Data sources: Council for Medical Schemes (cms.gov.za); Medical Schemes Act 131 of 1998; Insurance Act 18 of 2017; Stats SA healthcare inflation August 2025; Key Health Medical Scheme; Jobvira Health Guide 2026. Verified June 2026.