Compare what two South African medical-scheme options may cost your household—not only the monthly contribution, but savings, expected out-of-pocket costs and a difficult medical year.
Contributions are only one part of the decision. Estimate the day-to-day bills your household would submit and keep potential provider shortfalls visible.
Household on the membership
Your cost assumptions
02
Choose two options
Compare plans—not labels
A “hospital plan” from a registered medical scheme is not the same as hospital cash insurance. Every option below is presented as a medical-scheme option and remains subject to its registered rules.
Cover-level labels in the selectorsHospital-focused, Savings/intermediate and Comprehensive are broad comparison categories. They help organise the options but do not mean that plans in the same category provide equivalent benefits.
Any approved private hospital; day-procedure rules apply
Specialist cover
Medihelp tariff and benefit rules apply
Built-in medical savings
R 16 884 / year
Other modelled day-to-day funding
R 13 900 / year
Day-to-day structure
10% savings plus pooled insured benefits after savings is depleted.
Chronic cover
PMB and plan chronic benefits subject to rules
Watch forPooled limits, dental/optometry rules and scheme-tariff shortfalls.
03
Your comparison
See cost and risk side by side
This is a scenario result, not a recommendation. A lower expected cost can still come with tighter networks, lower provider rates or a larger cash reserve requirement.
Lower estimated annual cost after retained medical savings
Bonitas Medical Fund Hospital Standard
R 33 648 lower under your entered assumptions than MedPrime
Cost comparison only. The plans do not provide equivalent benefits.
Estimated costR 123 072after retained medical savings
Net modelled cash costR 123 072after subsidy and standard tax credit, including entered out-of-pocket costs
Retained savingsR 0estimated unused Medical Savings Account balance
Do not read this as equal-cover savings.The result compares estimated household cost. It does not put a rand value on wider hospital choice, oncology, chronic, maternity or other insured benefits. Unused medical savings are shown as retained healthcare value, not as cash available for general spending.
Benefits are not equivalent
What changes with the higher-contribution option?
MedPrime costs R 57 648 more a year in gross contributions than Hospital Standard. Compare what that additional contribution may provide before deciding.
MedPrime
Benefit areaHospital StandardMedPrime
Hospital access
Hospital network; 30% non-network co-payment
Any approved private hospital; day-procedure rules apply
Specialist cover
100% of the Bonitas Rate in hospital
Medihelp tariff and benefit rules apply
Chronic cover
PMB chronic cover at DSP; formulary rules apply
PMB and plan chronic benefits subject to rules
Day-to-day structure
Limited defined out-of-hospital benefits; no savings account.
10% savings plus pooled insured benefits after savings is depleted.
This summary is not a benefit guarantee. Confirm limits, networks, exclusions, co-payments, authorisation and clinical criteria in the official plan guide.
Three cost views of the same choice
Each bar shows estimated cost after the unused medical savings balance retained in that scenario.
Hospital StandardMedPrime
Expected yearR 33 648 difference
R 123 072R 156 720
High-use yearR 26 864 difference
R 142 572R 169 436
Major-event reserveR 26 864 difference
R 162 572R 189 436
Expected-year calculation
Hospital Standard
MedPrime
Gross scheme contributions
R 111 192
R 168 840
Of which: Medical Savings Account allocation
R 0
R 16 884
Contribution excluding Medical Savings Account allocation
R 111 192
R 151 956
Less employer subsidy
− R 0
− R 0
Less standard medical tax credit
− R 15 120
− R 15 120
Expected day-to-day bills
R 24 000
R 24 000
Less modelled savings and insured day-to-day funding
− R 0
− R 24 000
Day-to-day paid by household
R 24 000
R 0
Other co-payments and shortfalls
R 3 000
R 3 000
Optional gap-cover premium
R 0
R 0
Net modelled cash cost before retained savings
R 123 072
R 156 720
Less estimated unused Medical Savings Account retained
− R 0
− R 0
Estimated cost after retained medical savings
R 123 072
R 156 720
01
Can you use the network?
Check hospitals, GPs, specialists, pharmacies, oncology providers and day-procedure facilities near home, work and regular travel routes.
02
Can you fund the gaps?
Compare the contribution saving with the cash reserve needed for day-to-day bills, co-payments and provider charges above the scheme rate.
03
Are your medicines covered?
Confirm every chronic condition, medicine, formulary, DSP and registration requirement directly with the scheme before changing.
i
How this estimate works
The calculator adds annual contributions, expected household-paid day-to-day claims, shortfalls, gap-cover premiums and the selected stress reserve. It deducts the entered employer subsidy, the standard medical tax credit and modelled savings or insured day-to-day pools. It then deducts the estimated unused Medical Savings Account balance to show cost after retained healthcare value. Threshold benefits are simplified and only activate after the published threshold in this model.
Important interpretation
Educational comparison · not medical or financial advice
Benefit year
2026
Contributions and selected benefits were checked against scheme-owned 2026 sources on 1 August 2026.
Tax credit
2026/27 standard credit
It reduces qualifying income tax; it is not a cash discount from the scheme and cannot exceed tax otherwise payable.
Eligible claims
Rules still decide
Only eligible claims at the applicable scheme rate may count toward savings, limits or thresholds.
Retained savings
Healthcare value
The estimate assumes eligible day-to-day bills use medical savings first. An unused balance remains for eligible healthcare and is not general spending money.
Benefits compared
Not equivalent
The cost result does not assign a rand value to broader networks, oncology, chronic, maternity or other insured benefits.
PMBs
Not “everything in full”
DSP, authorisation, formulary and treatment-protocol rules may still determine how Prescribed Minimum Benefits are funded.
Gap cover
Separate insurance
Gap cover does not replace a medical scheme and has its own exclusions, limits and waiting periods.
Final decision
Confirm in writing
Obtain a current contribution quote, plan brochure, network list and benefit confirmation for your household and conditions.
Needs analysis