Medical Schemes Open Season 2026: Making the Right Choice for You

The annual medical scheme open season is here! Most schemes have now released their 2026 contribution rates and benefit updates, effective from 1 January. Whether you're satisfied with your current plan or considering a change, now is the time to review your options. Be sure to finalise your decision by late November or early December.

With a wide range of benefit options available, the process can feel daunting—but you don’t have to navigate it alone.

 Contact us to give you a comparison between at least 4 different schemes and or options if you want to use a specific scheme without any obligation.

✅ Key Considerations When Selecting a Medical Scheme or Benefit Option

Before locking in your choice, take time to explore your options thoroughly:

• Request an information brochure from us or your current or prospective scheme. Familiarise yourself with the scheme rules, benefit structure, and exclusions to ensure the option aligns with your healthcare needs and budget.

• Ensure you use a CMS-accredited healthcare broker to help you compare benefit options. This is optional but can be valuable if you're unsure where to start or need advice.

• Check for late joiner penalties or waiting periods, especially if you're joining a new scheme or have had a break in medical scheme membership.

• Understand your rights and the underwriting rules. While schemes may ask for your medical history, they may not charge higher contributions based on age or health status. Contribution differences may only be based on:

  • Your income,

  • The number of dependants, or

  • A combination of both.

• Know your Prescribed Minimum Benefits (PMBs). These are essential healthcare services that all schemes must cover in full—provided you use a Designated Service Provider (DSP). If you opt for a non-DSP, co-payments or benefit limits may apply.

• Review the scheme’s medicine formulary. If your prescribed medication isn’t on the approved list, you may need to cover the cost out of pocket.

• Be transparent when disclosing information. Incomplete or inaccurate disclosures can result in claim rejections or even termination of membership. [Click here to learn more about disclosure requirements.]

• Understand the difference between medical scheme cover and health insurance. These are distinct products with different regulatory frameworks and benefits.

If you’d like help comparing options or understanding your rights, feel free to reach out to us as registered healthcare broker. Making an informed choice now can save you stress—and money—later.

Also see our FAQ for more information.

If you belong to an employer group, you will be locked into their medical scheme agreements but will still have options within a scheme or between a number of schemes.

If you are an employer in need of a Group Medical Benefits, please contact us for assistance.

We have compiled a checklist to assist you in your process. Download the document here