5 Best Medical Aid Schemes That Cover Prosthetics 

Most South African medical aids include some level of prosthetic cover. Discovery, Momentum, Bonitas, Medshield, and Fedhealth all offer benefits, but limits, co-payments, and pre-authorisation requirements vary by plan. Some cover applies only under specific conditions, and not every type of prosthetic is included.   Cover for prosthetics is usually listed under assistive devices or external medical appliances. It’s often tied to annual limits, and approval usually depends on clinical motivation.   

Our guide compares the benefits of each scheme, breaks down the fine print, and outlines what to look for when reviewing a plan.   

• How Does Prosthetic Cover Work On Medical Aid In South Africa?
• Discovery Health: What Prosthetic Coverage Looks Like On Their Plans
• Medihelp’s Approach To Prosthetics
• Bonitas Medical Fund: How Prosthetic Benefits Work
• Momentum Health: Where Prosthetic Cover Fits In
• GEMS: Prosthetic Cover Across Its Benefit Options
• How To Check If Your Medical Aid Covers Prosthetics
• Common Prosthetics Exclusions (and Why They're Excluded)
• Common Issues With Prosthetic Cover
• Key Takeaways About Prosthetic Benefits On Medical Aid
• FAQ: Answers To Frequent Questions About Prosthetics And Medical Aid

  

and much, MUCH more!   

   

How Does Prosthetic Cover Work On Medical Aid In South Africa?

Prosthetics are often included in medical aid plans, but not always in obvious ways. Most medical schemes don’t have a section labelled “prosthetics” in bold. Instead, covers usually sit under categories like external medical appliances, assistive devices, or surgical appliances and prostheses. That can make it harder to determine what’s included or how much is covered.   

Prosthetic devices are typically split into two types:   

• Internal prosthetics, pacemakers, hip replacements, or spinal cages are usually handled under hospital benefits or prosthesis-specific limits.
• External prosthetics, artificial limbs, breast prostheses after mastectomy, or orthopaedic bracing. These are often grouped with assistive devices and capped at an annual amount.

  

Cover tends to vary by scheme, but some patterns are consistent across most plans:   

• Authorisation is required. Almost all schemes need a clinical motivation and a formal quotation before a prosthetic will be approved. In most cases, this should come from a specialist, not your general practitioner (GP).
• There’s usually an annual limit. Some schemes pay a set amount per year or per family for external prosthetics. Medihelp, for example, lists R11,300 per family on its MedAdd Elect plan. That amount may be pooled with other assistive devices.
• You’re often expected to use specific suppliers. Many schemes work with designated providers. If you don’t use one of these, you might have to pay the difference yourself, even if the prosthetic is approved.

  

Some benefits apply only to Prescribed Minimum Benefits (PMBs). If the prosthetic is required because of a PMB condition. For example, after a medically necessary amputation, full coverage may apply, but only if the correct process is followed. Not all prosthetics are included. 

Cosmetic devices are almost always excluded, and some schemes exclude high-end imported components unless there’s a local equivalent. Cover isn’t automatic, and it’s not always easy to find the limits in your plan guide.   

   

Discovery Health

Discovery includes prosthetic benefits across all its medical scheme plans, though how it's handled depends entirely on the option you’re on. External devices are mostly covered under assistive devices or surgical prosthetics, while internal devices are grouped with surgical appliances or hospital cover.   

What’s covered   

• External prostheses, such as artificial limbs, are covered under “prosthetic devices”.
• Internal prosthetic components are typically paid from the hospital benefit, provided the procedure qualifies.
• In specific cases (like joint replacements), costs may fall under surgical appliances rather than standalone prosthetic benefits.
• For amputations and physical rehabilitation, additional benefits may apply, such as physical therapy or gait training, depending on your plan.

  

Limits and co-payments

   

   

Pre-authorisation

Pre-authorisation is always required, no exceptions. Discovery may ask for:   

• A detailed clinical motivation from your treating doctor.
• Supporting diagnostic evidence (e.g., imaging, specialist reports).
• Multiple supplier quotes for external devices.

 

If prosthetics are part of hospitalisation, pre-authorisation is done under the related hospital admission request.   

   

Medihelp

Medihelp includes prosthetic benefits across several of its plans, although the way these benefits are packaged varies.   Some options combine prosthetics with appliances, while others only provide for prostheses when linked to reconstructive or restorative surgery. Internal prosthetics are usually included under hospital cover if they form part of an authorised procedure.   Cover depends heavily on the plan tier. The higher-tier options include set limits for external prosthetics, while lower-tier plans may exclude them unless they’re linked to Prescribed Minimum Benefits (PMBs).   

What’s covered   

• External prostheses are generally included in plans with day-to-day benefits, although they are often pooled with other medical appliances.
• Internal prostheses are included as part of surgical procedures that qualify for hospital authorisation.
• Prosthetics linked to PMB conditions are covered as part of PMB entitlements, subject to pre-authorisation.

  

Limits and co-payments

   

   

• All limits apply per family per year.
• Paid at the Medihelp tariff, which means you may carry a co-payment if your supplier charges more.

  

Pre-authorisation

Pre-authorisation is required for all prosthetic benefits, including those linked to PMBs. You’ll need:   

• A detailed clinical report
• Motivation from a treating specialist
• A formal quote from a recognised supplier

Authorisation is assessed on a case-by-case basis. Benefits are not automatic, even on plans that include a limit.   

   

Bonitas Medical Fund

Bonitas includes coverage for prosthetics on several of its plans, but the level of support depends entirely on the benefit option.   External prosthetics are covered under the category of “appliances and prostheses,” and there are defined annual limits per family. Internal prosthetics, such as surgical implants, are typically included under hospital-related benefits.   

Across plans, the benefit is capped, and strict authorisation rules apply. In most cases, Bonitas will only fund prosthetics if the item is medically necessary and prescribed by a specialist. Non-functional or cosmetic devices are excluded.   

What’s covered   

• External prostheses, including artificial limbs, are covered under “external prostheses”.
• Internal devices (e.g., joint replacements) are covered by hospital benefits or listed as internal prostheses.
• Some plans include coverage for repair or replacement within the plan’s annual limit.
• Benefits apply per family, not per person.

  

Limits and co-payments

Bonitas clearly outlines annual limits for prosthetic coverage on most of its plans. These limits apply to all appliances and prostheses combined.   

   

Pre-authorisation

Bonitas requires pre-authorisation for all external prosthetic devices. You’ll need:   

• A detailed clinical report from a specialist.
• A valid quote from a Bonitas-approved provider.
• Any applicable motivation forms completed in advance.

  

In-hospital prosthetics may also need separate authorisation, depending on the plan and whether the device is included under the relevant surgical procedure.   

   

Momentum Health

Momentum Health categorises prosthetic benefits into internal and external categories, both of which are capped. The cover is included in the Major Medical Benefit, but you’ll need pre-authorisation before any items are approved, including those linked to Prescribed Minimum Benefits (PMBs).   

Your plan determines your prosthetic allowance. The higher the tier, the higher the limit. Some plans also include extra event caps or require co-payments.   

What’s covered   

• External prosthetics (such as artificial limbs): covered up to a fixed family limit on most plans.
• Internal prosthetics (like joint replacements, pacemakers, and intraocular lenses): covered per event, with specific maximums depending on the device type.
• Prosthetics linked to PMBs are included across all plans, subject to pre-authorisation and clinical funding guidelines.

  

Limits and co-payments

   

   

• Intraocular lenses: R9,130 (Summit), R8,540 (others) per beneficiary per event.
• Cochlear implants: R234,000 (Summit), R214,000 (others), limited to 1 event per year.
• Co-payments may apply to related procedures or if you use a non-network provider.

  

Pre-authorisation

All prosthetic benefits require pre-authorisation. You’ll need:   

• A medical report and clinical motivation
• A quote from a registered supplier
• Confirmation that the procedure meets the clinical and scheme funding protocols.

  

If you skip this step, the scheme only pays 70% of the costs, unless it’s a medical emergency.   

   

GEMS

GEMS offers prosthetic benefits across all plan levels, but the limits and terms vary significantly. The cover is split between a general prosthetics cap and an additional limit for joint revision. A separate, shared sub-limit applies to orthotics, braces, and assistive devices.   

There are six plan options: Tanzanite One, Beryl, Ruby, Emerald, Emerald Value, and Onyx. Prosthetic benefits apply mainly to in-hospital procedures and are subject to scheme rules and managed care protocols.   

What’s covered   

• Internal and external prostheses, including joint replacements.
• Assistive devices like orthotic shoes, braces, and CPAP devices fall under separate annual caps.
• Prosthetics linked to Prescribed Minimum Benefits (PMBs) are included on all options, subject to authorisation and clinical criteria.

  

Limits and sub-limits

   

   

• Notes on shared sub-limits:
• Crutches: R701 per beneficiary per year.
• Wheelchairs: R7,716 every 24 months.
• Hearing aids: R11,223 every 36 months.
• CPAP device: R13,328 every 36 months.
• Braces (knee/back): R3,499 each per year.
• Pulse oximeter: R467 per family per year.
• Compression stockings: Up to 3 pairs, R584 per pair per year.

  

Pre-authorisation

Pre-authorisation is mandatory for all prosthetic-related procedures. GEMS requires:   

• Specialist clinical motivation
• Itemised quotations
• Diagnostic justification that aligns with benefit rules

  

Hospital admissions for prosthetic procedures must follow the GEMS DSP (Designated Service Provider) network, where applicable, especially on Tanzanite One and Emerald Value. Non-network use triggers a R15,000 co-payment unless it’s an emergency or a facility falls outside the 50km rule.   

   

How To Check If Your Medical Aid Covers Prosthetics

Medical aid brochures aren’t always clear about prosthetic benefits. In many cases, you won’t find a neat “prosthetics” heading. Instead, the benefit is typically grouped under categories such as appliances, assistive devices, external medical devices, or surgical items. 

Some are buried in annexures, and others need a decoder ring (or three calls to the scheme's call centre).   You must always check and confirm; there are a few steps you can take to determine what’s available on your plan and what’s not.

  

Start With Your Plan Guide

Your plan brochure is the best place to begin, but prosthetics may not be listed as a separate benefit. Instead, you’ll need to look under sections like assistive devices, external medical appliances, prostheses, or surgical items. Even then, it’s not always obvious what’s included. What to check:   

• Does the plan cover internal and/or external prostheses?
• Is the benefit part of hospital cover or a separate device limit?
• Does the limit apply per family or beneficiary?
• Are prosthetics lumped together with hearing aids, wheelchairs, or braces?
• Is the cover linked to Prescribed Minimum Benefits (PMBs) only?

  

On many plans, external prosthetics are only paid for when linked to a hospital procedure, and not all procedures qualify.   

Watch For Exclusions - They’re Not Always Obvious

Exclusions are typically listed in their section, but may also be scattered throughout the document. Even if a prosthetic is medically necessary, it might still be excluded based on how it’s classified. Some standard exclusions include:   

• Cosmetic or non-functional prosthetics.
• Imported components when a local equivalent is available.
• Repairs or replacements (some only cover the first fitting).
• Non-essential enhancements or high-performance devices.

 
Common prosthetic exclusions across medical aids
   

   

Speak To The Scheme Directly

Once you’ve checked the paperwork, it’s worth confirming the benefit in writing, especially if you’re planning a surgery, prosthetic fitting, or device replacement. 

When you call or email, ask:   

• What does your current plan allow for internal and external prosthetics?
• Whether there is a limit (and if it resets annually or by event).
• If a DSP (Designated Service Provider) must be used.
• Whether they require more than one quote.
• What documents do they need to process an authorisation?

Most schemes will issue a benefit confirmation letter; ask for it. That way, you’ve got something to refer back to if the claim is disputed.   

Bring Your Specialist In Early

Your medical aid won’t approve anything without a clinical motivation, and your specialist is the one who needs to submit it. A casual referral or a one-liner won’t do it. 

What the scheme usually wants:   

• A detailed diagnosis and the clinical reason for the prosthetic are required.
• The ICD-10 codes and relevant procedural codes.
• An itemised quote from a recognised supplier.
• Any relevant medical records or diagnostic imaging reports.

 

A vague or incomplete motivation is one of the most common reasons prosthetic claims are delayed or rejected entirely.   

   

Common Prosthetics Exclusions (and Why They're Excluded)

Even if a plan includes prosthetic benefits, that doesn’t mean everything is covered. Most medical aids apply exclusions to control cost, limit liability, or avoid funding devices they categorise as elective, cosmetic, or non-essential.   Some of these exclusions make sense from a policy point of view. Others are… let’s say, generous with their interpretation of “not medically necessary.”   Here’s what’s usually left out - and why it matters when you're comparing cover.   

Cosmetic Prosthetics

These are typically excluded unless the device restores basic function after trauma or surgery. A prosthetic hand with passive cosmetic function (no gripping ability) is often not funded unless it’s part of a reconstructive process.   Schemes argue that devices without a functional benefit don’t qualify under essential healthcare. That can be especially limiting in cases where appearance affects a person’s independence or social reintegration, but the policy rarely makes exceptions.   

Imported or “Non-Standard” Components

Imported limbs, high-performance materials (like carbon fibre), or parts that exceed local scheme rates are usually excluded unless there’s no local equivalent.   In these cases, the issue isn’t whether the device works; it’s about cost and standardisation. If there’s a South African supplier and the scheme has a tariff for it, they’ll insist you use that. If you go outside that network or specification, expect a co-payment or complete rejection.  

 

Routine Upgrades or Replacements

Some schemes exclude repeat replacements unless there's a clinical motivation for it, even if the limb no longer fits well or causes discomfort.   This often affects children, whose devices need to be replaced more frequently due to growth. Unless the plan includes a specific paediatric prosthetic clause (which is rare), you may need to fund those updates privately.  

 

Battery-Powered or Advanced Electronic Components

While some schemes cover basic mechanical prosthetics, they draw the line at devices with smart tech or power-assisted features - unless these are explicitly pre-authorised and justified as essential for mobility or daily function.   Expect scrutiny on:   

• Myoelectric limbs.
• Microprocessor knees.
• Sensor-assisted gait components.

 

If these aren’t listed in your plan’s approved appliance schedule, they’re likely to be excluded or capped well below their cost.   

Common Exclusions and Rationale

   

   

   

Common Issues With Prosthetic Cover

Prosthetic benefits on paper don’t always match what happens in practice. The cover may exist, but obtaining it authorised, approved, and paid for includes an administrative loop. If you're comparing plans or trying to claim, these are the usual points of friction.

   

Authorisation Takes Time (And Energy)

Every scheme requires authorisation, but that’s the beginning of the admin, not the end.   

• A full clinical motivation is always needed, usually from a specialist.
• You’ll need a quote from a recognised or network supplier.
• Schemes sometimes request a second quote or refer the case to a medical panel for review.

  

Some go further, asking for proof that no cheaper alternative is available. Others want supporting diagnostic records. Timelines vary, but it’s rarely the same day.  

 

Cover Isn’t Always In The Part Of The Plan You’d Expect

Even when prosthetics are needed after a medical procedure, you can’t always assume the hospital benefit pays for them. Some schemes bury the cover under assistive devices. Others split the limit across unrelated equipment.   

• Assistive devices often include crutches, wheelchairs, hearing aids, and prosthetics under one total limit.
• Savings plans may only pay if funds are available at the time of claim.
• Hospital-only plans generally exclude external prosthetics unless part of a PMB-linked event.
• Plans with Above Threshold Benefits (ATBs) may only unlock prosthetic cover once you hit your spend threshold.

  

Some funds list prosthetics separately, but only cover specific body parts, not full limb replacements.   

Where Schemes Usually Place Prosthetic Benefits

   

   

Co-Payments Often Catch People Off Guard

Plans don’t always shout about co-payments — but they’re baked into the benefit structure on most options. Even when prosthetics are covered, you might still need to pay for:   

• Any amount charged above the scheme rate (e.g., Discovery Health Rate or Bonitas Rate).
• Devices from non-network providers or outside the DSP system.
• Specialised components or imported items that aren’t on the scheme’s preferred list.
• Fitment, adjustments, or aftercare that fall outside the scope of the benefit.

  

Some schemes will only reimburse a portion of the cost if the item isn’t pre-approved, even if you’re technically covered. 

  

Limits Are Often Too Low

Most benefit caps for external prosthetics range from R11,000 to R30,000 per year. The actual cost of a new limb, including fitment, sockets, and support, often far exceeds the initial price.   Some below-knee prosthetics start at R40,000. Above-knee? That can triple. Add sensors, batteries, or specialised suspension? You’re looking at R100,000 or more in many cases, which makes those neat-sounding limits less generous than they appear.   

Cover is better than none, yes. However, you’ll often need to fund the shortfall yourself, or fight the scheme to recognise the medical necessity of a device beyond the default option.   

   

In Conclusion

Prosthetic coverage varies widely, and much of it depends on where the benefit sits within your plan. Some cover internal prosthetics during surgery but exclude external limbs entirely. Others cap the benefit or tie it to specific conditions. You won’t always find a clear heading or list of inclusions.   Instead, the benefit might be grouped with assistive devices or appliances, often sharing a total limit with unrelated equipment. The approval process tends to be admin-heavy, involving reports, authorisations, quotes, and waiting periods.   

Co-payments are common, and benefit limits often don’t match the real-world cost of the device. If a prosthetic is medically necessary, it’s important to confirm how it’s funded, who needs to authorise it, and whether any network or provider rules apply.   The more you clarify upfront, the less you’ll be caught off guard later, especially with something this specialised, personal, and expensive.   

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Frequently Asked Questions   

Does medical aid in South Africa cover prosthetics?

Yes, most medical aids include prosthetic coverage; however, the benefit limit, process, and device types depend on your specific plan. External devices often fall under assistive or surgical appliance benefits.   

Does medical aid cover prosthetics for children?

Some plans do, but replacements due to growth aren’t always included. You’ll need pre-authorisation and a clinical motivation either way.   

Does medical aid cover cosmetic prosthetics?

Usually not. If the device doesn’t restore function, it’s often excluded.   

Do all medical aids cover external prosthetics?

No. Some only include them on higher-tier options or when linked to a Prescribed Minimum Benefit condition.   

Does medical aid cover the repair or replacement of prosthetics?

Sometimes, but it depends on the benefit rules. Some limit this to the initial fitting only.