Switching benefit options within your medical scheme

But don't just look at the price. Look at your hospital cover, day-to-day benefits, chronic medicine support, preventative screenings, and enhanced benefits like dental or optical. Make sure the doctors and specialists you visit most are still covered within the option rules and networks. If you value proactive health management, consider options that place greater emphasis on prevention and early detection.

Medshield has designed its 2026 benefits around the Partner for Life strategy – meaning that as your needs change, your option should change with you.

No waiting periods when changing options

One of the most significant advantages of changing options within the same medical scheme is that waiting periods do not apply during the annual option change window. Your membership history stays intact, and you keep continuous access to benefits.

However, if you downgrade, some benefits may have different limits or payment structures. If you upgrade, additional benefits – such as higher benefit limits, hospital cover or new screening allowances – only activate from 1 January, when the new option becomes effective.

Take time to compare how your benefits will change when you change options.

Your life stage matters

Medshield's benefit options are structured to follow you through your life stages:

• Young adults entering the job market may prefer lower-cost options that offer essential coverage.
  
• Growing families may require more substantial day-to-day benefits, preventative care, maternity and paediatric support.
  
• Mature adults and retirees may need more comprehensive, risk-rich cover with higher chronic and in-hospital benefits.

As your life changes – marriage, children, new diagnoses, increased healthcare needs – your option should change too. It is the heart of Medshield's Partner for Life philosophy: keeping you covered, sustainably and appropriately, for the long term.

Look at value, not just price

Medshield offers value and stability by having one of the highest solvency levels of any open scheme, strong financial performance and consistent membership growth, careful pricing supported by independent actuarial input, and a strategy of smoothing increases so members are not hit with sudden spikes. Therefore, when choosing an option, ask yourself:

• Does this option match my day-to-day needs?
  
• Am I using up my benefits too quickly?
  
• Will this reduce my out-of-pocket costs?
  
• Does the option support preventative care, chronic management or screening needs?

A well-matched plan can save you money in the long run and give you peace of mind.

Prevention-first benefits

Medshield's 2026 product improvements place significant focus on prevention rather than cure, supporting the scheme's long-term sustainability and member health. Some updates include:

1. Expanded optical benefits

• Annual eye tests paid from risk, not from day-to-day or optical limits.
  
• Significant increases to frame and lens limits across options.
  
• Optical limits now apply per beneficiary rather than per family – helping families with children access more appropriate cover.
  
• Improved affordability for contact lenses and corrective eyewear.
  
• These changes support earlier detection of vision problems, eye strain, and chronic conditions such as diabetes and glaucoma.

2. Enhanced diabetes support

• AI-enabled diabetic retinal screening added as a preventative benefit.
  
• Continuous glucose monitoring (CGM) for children up to age 18, funded up to R26,500 per beneficiary per year on applicable options (e.g., MediSaver and PremiumPlus). CGM is life-changing for young members, allowing them to avoid multiple finger-prick tests each day.

3. Annual mammograms from age 30

Instead of the usual 24-month cycle from the age of 40, most options now allow annual mammograms for women 30+ years old, funded from risk, supporting earlier breast cancer detection.

4. Improved day-to-day and dental/optical allowances on selected options

This includes:

• Higher day-to-day limits.
  
• Enhanced savings and above-threshold structures on the executive savings option.
  
• Removal of co-payment structures to reduce financial shocks during medical procedures.

These benefits are designed to detect potential health issues early, reduce hospital admissions, and ultimately protect members from more serious complications and out-of-pocket costs. Early detection saves lives – and choosing an option that supports this can make a meaningful difference.

Make an informed decision

Before completing your option change, you should review your past year's claims, consider upcoming life or health changes, compare benefits using the latest Medshield 2026 benefit guides, and consider preventive care and chronic needs.

Choose the option that best fits your life stage and budget. Your medical scheme option is an essential part of your financial and health planning. Reviewing it annually ensures your cover keeps up with your needs and continues to deliver the value and security you expect.

The timing will matter

Medshield Medical Scheme members are free to change between benefit options or plans within the same scheme once a year during November and December, and the change will be effected on 1 January 2026. Should you choose not to change your benefit option, you will automatically remain on your current option for 2026.

It is also the best time to switch if you want to move from your current medical scheme to Medshield. All your specific details and medical history will be recorded for ease of reference when you begin your new journey with us. We welcome all new members, individual or corporate and offer a wide range of benefit options tailored to specific needs. Visit our website for more.