Still recovering from festive spending? Your healthcare costs shouldn’t be the next surprise. For South Africans on medical aid, January is the most valuable time to lock in smart healthcare moves.
Think of it like a reset button for your healthcare. Get ahead now, and you’ll avoid unnecessary payments, claim rejections, and late-year panic.
Here are five simple but powerful tasks you can do this month to make sure your medical aid works for you.
1) Set up your preventive screenings early
Most medical aid schemes in South Africa cover essential preventive health screenings at no cost to you. These include:
- Pap smears
- Mammograms
- Prostate exams
- Cholesterol checks
- Glucose tests
These medical aid benefits are often paid from your risk portion, not your savings, meaning they don’t reduce your available day-to-day funds.
January is the best time to book them. Not only are healthcare providers typically less busy, but it’s also easier to secure appointments that fit your schedule. Booking early also reduces the chance of forgetting about them altogether. Some schemes, like Discovery’s Personal Health Fund, reward members for staying proactive about their health. When you complete your annual health checks, you can unlock funds in your Personal Health Fund to use for everyday medical needs – including physio, mental health support or other out-of-hospital expenses. Many other medical schemes offer similar incentives for preventive care, encouraging members to act early rather than waiting until something goes wrong.
2) Check your savings and day-to-day medical aid benefits upfront
One of the easiest ways to lose money on medical aid is to misunderstand how your plan splits benefit between risk and savings.
Start by logging into your medical aid app or online portal. A healthcare broker can also help you with your needs analysis.
Take note of your:
- Available medical savings balance
- Annual day-to-day benefit limits
- What services are covered under “risk” (typically includes screenings, chronic medication, immunisations)
For example, children’s vaccinations and dental checkups are usually paid from risk. But if you don’t claim them correctly or if the provider isn’t coded correctly, you could unintentionally use up your savings early in the year.
A few minutes now can help you avoid using your entire savings allocation before March.
3) Download your scheme’s app and activate digital authorisations
Medical aid apps are more than just balance checkers. They help you manage your medical aid benefits in real time.
If you haven’t already, download your scheme’s app and explore features like:
- Digital pre-authorisations for hospital visits or specialist consultations
- Claim submissions via photos or digital uploads
- Provider search tools to find network-approved doctors or hospitals
- Real-time benefit tracking
This isn’t just about convenience. If you can submit claims and authorisations quickly, you reduce the risk of delays or admin errors that lead to out-of-pocket payments. Plus, getting to grips with the app now means you’re ready when a real medical need arises later.
4) Make sure dependents still meet eligibility rules
Many members get caught out by dependent eligibility changes, especially after December, when children turn 21 or return to university.
Most medical aid schemes require updated documents for adult dependents. If your child is over 21 but still studying, you’ll likely need to submit a proof of registration or similar documentation. If that’s not done, they may be removed or reclassified as adult members, which often means:
- Higher monthly premiums
- Claims being rejected unexpectedly
Also, check whether new dependents (like a baby born in December) have been added and approved. Don’t assume the paperwork is automatic.
5) Review your DSPs for medication and planned procedures
Designated Service Providers (DSPs) are a critical part of managing your medical aid costs. Every scheme has a network of preferred:
- Pharmacies
- Hospitals
- Medical specialists
- Dentists
- General Practitioners (GP)
If you use a provider outside your scheme’s Designated Service Provider (DSP) network, especially for chronic medication or planned procedures, you could face steep co-payments. Gap cover can help you with these types of co-payments
In January, go through your scheme’s updated 2026 DSP list. Make sure your:
- GP is still in-network
- Pharmacy is listed for chronic meds
- Hospital choice for planned procedures is covered
If you need to switch providers, better to do it now before you need treatment.
For example, getting chronic medication from a pharmacy not on your network, can lead to an on average 30% co-payment (be sure to confirm with your broker and your scheme what sort of co-payment applies to your specific option. That’s a costly mistake that’s easy to avoid with a quick check.
Final Tip: One hour now can save you thousands later
Medical aid in South Africa is complex, but it’s not beyond your control. Spending just an hour in January reviewing your medical aid benefits, checking balances, and updating documents can save you thousands in avoidable expenses later in the year.
Think of it like setting up debit orders or doing your tax prep. It’s admin that pays off.
Already locked into your 2026 plan? No problem. You can still use CheckMed to compare medical aid benefits, understand how your plan stacks up, and prepare better questions for your broker or scheme. It’s a smart way to stay informed, so your medical aid works for you all year.
