Medical Schemes Open Season 2026: How to choose a medical scheme or benefit option
It is open season for medical scheme members! Most schemes have now announced their 2026 contribution and benefit updates, which take effect from 1 January. Whether you are happy with your current option or thinking about switching, be sure to review your choices and finalise your decision by late November or early December.
With so many options available, choosing the right one can feel overwhelming, but you do not have to figure it out alone. The CMS has put together a quick guide to help you make an informed decision.
Handy tips to consider when choosing a medical scheme
Contact your current or potential scheme for an information brochure and get familiar with the scheme rules and benefits before choosing an option that fits your needs and budget.
Remember, you may also use a healthcare broker that is registered with the CMS to review benefit options, but this is not compulsory.
Before you commit, take a moment to:
- Understand your rights and the fine print that could influence the scheme’s decision-making process. While it is important to provide information such as medical history, your medical scheme cannot charge you more because you are older or living with an illness. Contribution differences may only be based on:
- Income
- number of dependants, or
- both
- Familiarise yourself with the Prescribed Minimum Benefits (PMBs) to know what your scheme will cover in full if you use a Designated Service Provider (DSP), and any co-payments and limits that may apply if you choose a non-DSP. Learn more about DSPs and emergency care here.
- Review the medicine formularies because if your prescribed medicine is not on the scheme’s approved list, you have to make out-of-pocket payments.
- Find out what late joiner penalties or waiting periods may apply to you if you are joining a new scheme. Click here to read more on disclosure of information, as failure to do so may lead to denied claims or even termination of membership.
- It is also essential to know the difference between medical scheme coverage vs. health insurance.
The CMS is committed to helping you make informed choices and protecting your rights as a medical scheme member.
Download our comprehensive guides on choosing a medical scheme.
