4 Best Medical Aid Co Payment Cover in South Africa
The 4 Best Medical Aid Co-Payment Cover in South Africa revealed.
We tested them side by side and verified their medical aid plans.
This is a complete guide to the best medical aid co-payment cover in South Africa.
In this in-depth guide you’ll learn:
- ✅ What is Medical Aid Co-Payment Cover?
- ✅ Which hospital plans offer co-payment coverage in South Africa?
- ✅ How to choose the best affordable medical aid for your needs?
- ✅ How to compare medical aids and hospital plans against each other?
- ✅ What is the best way to sign up for medical aid for the first time?
- ✅ How do you choose the best medical aid for your family?
So if you’re ready to go “all in” with the best medical aid co-payment cover in South Africa, this guide is for you.
Let’s dive right in…
4 Best Medical Aid Co-Payment Cover Summary
- Discovery Health Medical Scheme – Overall, Best Medical Aid Co-Payment Cover
- Fedhealth Medical Scheme – Best Low-Cost Medical Coverage
- Momentum Health – Third-Largest Medical Insurance Provider
- Bonitas Medical Fund – Top Managed Care Programme
4 Best Medical Aid Co-Payment Cover in South Africa
👉 A co-payment is an additional form of medical insurance that covers the difference between the amount that a medical aid programme pays for a medical procedure and the actual cost of the procedure.
👉 It makes up the difference between what the patient’s medical aid contributes and what the patient is responsible for paying out of pocket, making it possible for the patient to more easily afford the care they require. Compare medical aid rates and benefits.
👉 There are a few different co-payment providers in South Africa who incorporate co-pay cover within the benefit packages of their products.
👉 The 4 best medical aids that provide co-payment coverage in South Africa are:
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The difference between gap cover and co-payment.
The difference between gap cover and co-payment lies in their purpose and how they function within the healthcare system:
Co-payment:
- ✅ Purpose: To share the cost of healthcare between the patient and the medical aid scheme.
- ✅ How it works: The patient pays a predetermined amount (either a fixed amount or a percentage) for specific medical services, while the medical aid covers the remaining cost.
- ✅ Initiated by: The medical aid scheme.
Gap cover:
- ✅ Purpose: To bridge the financial gap between what the medical aid scheme pays and what the healthcare provider charges.
- ✅ How it works: The patient pays the full amount to the healthcare provider, then claims the difference (the “gap”) from the gap cover insurer.
- ✅ Initiated by: The patient.
In essence:
- Co-payment is a predetermined amount you pay upfront for a medical service, while gap cover reimburses you for the difference between what your medical aid pays and what the healthcare provider charges.
Key points to remember:
- 💙 Not all medical aid schemes require co-payments.
- 💙 Gap cover is an optional insurance product that can be purchased to supplement your medical aid.
- 💙 It’s essential to understand the terms and conditions of both your medical aid and your gap cover policy to ensure you know what is covered and what your out-of-pocket expenses will be.
1. Discovery Health Medical Scheme
👉 Coverage that is all-inclusive, including coverage for co-payments, is provided through the Discovery Health Medical Scheme. Depending on the level of cover that was selected, this protection allows members to submit claims for up to one hundred per cent of the cost of treatment and medication.
👉 This is an amount that you have to pay towards a healthcare service. The amount can vary, depending on the type of healthcare service, the place of service and whether the amount that the service provider charges is higher than the rate that we cover.
👉 If the co-payment amount is higher than the amount charged for the healthcare service, you will have to pay for the cost of the healthcare service.
👉 Depending on your chosen plan, you may need to use specific hospitals, doctors, specialists or allied healthcare professionals in a network.
👉 We have payment arrangements with these providers to make sure you can access quality care that is affordable. When you use a network provider, you avoid having to pay extra costs and co-payments.
👉 To be covered in full for your GP consultations, you must visit your nominated Primary Care network GP.
👉 If you see a GP who is not your nominated Primary Care GP or a nominated GP that is not a network GP, you will have to pay a co-payment.
Read more about Discovery Health Comprehensive Series
2. Fedhealth Medical Scheme
👉 Coverage that is comprehensive, including coverage for co-payments, is provided under the Fedhealth Medical Scheme. Depending on the level of coverage that was selected, this protection allows members to submit claims for up to one hundred per cent of the cost of treatment and medication.
👉 By law, all medical schemes are required to cover the treatment of 270 hospital-based conditions and 27 chronic conditions, i.e. the Chronic Disease List (CDL), in full without co-payment or deductibles, as well as any emergency treatment and certain out-of hospital treatment.
👉 A co-payment applies to non-PMB MRI/CT scans on all options.
👉 On Fedhealth, injuries that require medical treatment like stitches or the setting of a fractured bone, are covered whether you’re admitted to hospital or not. Authorisation must be obtained within 48 hours and a co-payment of R850 per visit for non-PMBs applies to all options.
👉 On certain options, members must use the Fedhealth Hospital Network or pay a co-payment on the hospital account.
👉 Co-payments are applicable to the voluntary use of non-DSPs. Referral must be obtained from a Fedhealth Network GP for consultations with Fedhealth Network Specialists. If referral is not
obtained, there will be a co-payment on specialist claims paid from the Risk benefit. Co-payments are option dependent.
👉 For some treatments and procedures, members must pay an amount out of their own pocket. Co-payments apply to the hospital account and/or certain procedures, depending on the option.
✅ Read more about GAP cover
3. Momentum Health
👉 Comprehensive coverage is provided by Momentum Health, including coverage for co-payments. Depending on the level of coverage that was selected, this protection allows members to submit claims for up to one hundred per cent of the cost of treatment and medication.
👉 The HealthSaver account can be used not only to fund healthcare related expenses, such as
- ✅ co-payments,
- ✅ cosmetic surgery,
- ✅ refractive eye surgery,
- ✅ vitamins,
but also your monthly medical scheme contribution,
provided you are the contribution payer and you have
accumulated sufficient funds to do so.
Momentum GapCover:
💙 Covers co-payments applied by the medical scheme for certain specialist procedures and hospital admissions.
💙 On GapCover Supreme it covers the 20% co-payment applied to oncology treatment after the medical scheme limit has been reached.
👉 On the Evolve Option a R1 920 per authorisation, except for motor vehicle accidents, maternity confinements, emergency treatment and when you involuntarily use a non-designated Service Provider.
* An additional co-payment may apply for certain specialised procedures.
READ more about the 5 Best Hospital Plans for Pregnancy Coverage in South Africa compared and revealed
4. Bonitas Medical Fund
👉 Bonitas Medical Fund: Bonitas Medical Fund offers comprehensive cover which includes co-payment cover. This cover allows members to claim up to 100% of the cost of treatment and medication, depending on the level of coverage chosen.
👉 Potential members have the following options: BonComplete, BonClassic and BonComprehensive. The latter is a first-class savings plan that offers ample savings, an above-threshold benefit and extensive hospital cover.
👉 Bonitas Medical Fund offers several co-payment plans, including the Bonitas Classic Co-payment and the Bonitas Comprehensive Co-payment.
For Example:
On the BonCap Plan
- ✅ The NON-NETWORK GP CONSULTATIONS a 30% co-payment applies, unless it is a PMB.
- ✅ For acute medicine and blood tests: 20% co-payment applies at non-DSP
- ✅ If you choose not to use a DSP for contraceptives, a 40% co-payment applies
- ✅ And more – Read the BonCap brochure from Bonitas.
On the Hospital Standard Plan
- ✅ For MRIS AND CT SCANS a R2 800 co-payment per scan event except for PMB.
- ✅ For CANCER TREATMENT, avoid a 30% co-payment by using a DSP.
- ✅ For DAY SURGERY PROCEDURES, avoid a R2 720 co-payment by using a network day hospital.
- ✅ And more – Read the Hospital Standard brochure from Bonitas.
Other providers of Co-payment in South Africa
Stratum Benefits
👉 The ACCESS CO-PAY PLUS300 plan offered by Stratum Benefits includes a limit of R 210 580 per insured person per year.
👉 Admission and Procedure Co-Payments – Claim co-payments when admitted to a day clinic or hospital or before undergoing a medical procedure, such as an in- or out-of-hospital scope or scan. Limited to R 6 500 per policy per year.
👉 When clients receive medical treatment, Sirago helps them avoid having to pay for it by providing co-payment. Coverage is available for a variety of medical services and expenses, including hospitalisation, day-to-day costs, long-term medication, and others. In addition to this, it offers top-up benefits to medical aid members who are interested in receiving additional benefits.
💙 Download the 2025_Access_Co-Pay_Plus300-Condensed
Liberty Health
👉 Liberty Health offers full coverage for any and all co-payments associated with hospital admissions, scans, and some treatments for customers who select either the Essential or the Universal co-payment option.
💙 Download the liberty-gap-cover-2025-brochure
👉 The Essential and Universal co-payment alternatives that are offered by Liberty Health are intended to assist in covering the gap that exists between the medical scheme tariffs and the medical costs that are charged by providers.
👉 Cover for co-payments imposed by medical aid for hospital admissions, CT, PET and MRI scans and specified medical procedures.
👉 This benefit is intended to cover co-payments imposed by medical aid for in-hospital treatment
and on the over 50 out-of-hospital procedures we cover.
👉 Dentistry (in-hospital) and cancer treatment (not medicine) co-payments are covered.
👉 Penalty co-payments charged by medical aids are not covered. No cover is provided for the penalties imposed e.g. not obtaining a general practitioner referral prior to consulting with a specialist; not obtaining a pre-authorisation prior to a procedure; not following assessment criteria of medical aid back and neck program prior to undergoing spinal surgery.
Frequently Asked Questions
How much does medical co-payment cover cost?
Depending on the provider and the type of coverage chosen, co-payment prices change. The cost of co-payments can vary from R300 to R680 per month, with the precise amount depending on the level of coverage chosen. You should browse around to find the most reasonable alternative because some insurance companies offer discounts to consumers who buy many policies from them.
How does co-payment cover differ from other types of insurance?
Depending on the provider and the type of coverage chosen, co-payment prices change. The cost of co-payments can vary from R300 to R680 per month, with the precise amount depending on the level of coverage chosen. You should browse around to find the most reasonable alternative because some insurance companies offer discounts to consumers who buy many policies from them.
What are the benefits of having medical co payment cover?
Co payment cover or Gap cover as it is also known assists in covering the additional expenses incurred after receiving medical treatment. It can assist you in avoiding out-of-pocket expenses so you can focus on getting healthier. If you find yourself suddenly needing hospitalization, it can spare you the stress of having to worry about money.
How can I find out if my medical aid offer co-payment cover?
If there is no information on your medical assistance provider’s website, you can call them to ask about co-payment coverage.
Can I purchase co-payment cover separately if my medical aid does not provide it?
If your medical assistance does not offer co-payment insurance, you can buy it from a different company. Be aware that co-payment choices supplied by medical aid providers generally offer more possibilities than those offered by third-party providers.
What types of co-payment cover are available?
Co-payment options may also cover extra costs like dental and vision treatment. Co-payment options should cover the gap between medical assistance rates and the rates charged by medical providers.
