Options Overview
SABMAS is a closed corporate medical scheme. We aim to give our members the best of both worlds.
The Essential Option is a traditional option, while the Comprehensive Option adds savings for co-payments and discretionary medical expenses. Both include a wellness component promoting health awareness, preventive care, and early detection. Refer to page 5 for a comparison to choose the best option for your needs and budget.
Changing Between Options
Please note that you can only change between the Comprehensive and Essential Options at the end of the year for the following year. Specific dates for the Option change window period are published www.sabmas.co.za. During this time, you can change either from Essential to Comprehensive, or vice versa. Please remember that Option changes take effect on 1 January each year.
Choosing the Right Benefit Option
The table below gives you a brief summary of the different benefits and inclusions we offer on the Essential and the Comprehensive Options. See at a glance the benefits offered for each Option to help you make an informed decision.
2026 Contributions
Essential Option
Affordable Care with Essential Benefits
Enjoy peace of mind with tailored sub-limits for day-to-day medical expenses, hospitalisation coverage through the Major Medical Risk Pool, and proactive wellness support.
Coverage Includes:
- Sub-limits for day-to-day medical expenses
- Hospitalisation cover & major medical expenses
- Wellness Benefit
2026 Contributions
ESSENTIAL OPTION
TOTAL MONTHLY CONTRIBUTION (INCLUDES 10% SAVINGS)
BASIC MONTHLY
INCOME (R)
MEMBER
ADULT
DEPENDANT
OVER 21
CHILD
DEPENDANT
UNDER 21
0 - 7 200
R1 699
R1 699
R507
7 201 - 11 100
R1 995
R1 995
R595
11 101 - 14 700
R2 052
R2 052
R611
14 701 - 18 400
R2 119
R2 119
R638
18 401 - 22 000
R2 185
R2 185
R654
22 001 - 25 700
R2 256
R2 256
R677
25 701 - 29 500
R2 346
R2 346
R702
29 501 - 36 900
R2 432
R2 432
R732
36 901 - 44 000
R2 517
R2 517
R760
44 001 - 50 700
R2 608
R2 608
R784
50 701 - 57 500
R2 687
R2 687
R806
57 501+
R2 767
R2 767
R832
Comprehensive Option
Comprehensive Coverage, & more
Maximise your health benefits with a Member Savings Account (10%), full coverage for day-to-day medical expenses, extensive hospitalisation coverage, and a wellness programme designed for you.
Coverage Includes:
- Member Savings Account (10%)
- Routine day-to-day, cover
- Hospitalisation & major medical expenses
- Wellness Benefit
2026 Contributions
COMPREHENSIVE OPTION
TOTAL MONTHLY CONTRIBUTION (INCLUDES 10% SAVINGS)
BASIC MONTHLY
INCOME (R)
MEMBER
ADULT
DEPENDANT
OVER 21
CHILD
DEPENDANT
UNDER 21
0 - 7 200
R4 044
R4 044
R1 213
7 201 - 11 100
R4 330
R4 330
R1 304
11 101 - 14 700
R4 422
R4 422
R1 328
14 701 - 18 400
R4 510
R4 510
R1 350
18 401 - 22 000
R4 602
R4 602
R1 389
22 001 - 25 700
R4 706
R4 706
R1 408
25 701 - 29 500
R4 798
R4 798
R1 441
29 501 - 36 900
R4 898
R4 898
R1 467
36 901 - 44 000
R4 984
R4 984
R1 491
44 001 - 50 700
R5 078
R5 078
R1 521
50 701 - 57 500
R5 181
R5 181
R1 549
57 501+
R5 286
R5 286
R1 580
Essential Option
Affordable Care with Essential Benefits
Enjoy peace of mind with tailored sub-limits for day-to-day medical expenses, hospitalisation coverage through the Major Medical Risk Pool, and proactive wellness support.
Coverage Includes:
- Sub-limits for day-to-day medical expenses
- Hospitalisation cover & major medical expenses
- Wellness Benefit
Comprehensive Option
Comprehensive Coverage, & more
Maximise your health benefits with a Member Savings Account (10%), full coverage for day-to-day medical expenses, extensive hospitalisation coverage, and a wellness programme designed for you.
Coverage Includes:
- Member Savings Account (10%)
- Routine day-to-day, cover
- Hospitalisation & major medical expenses
- Wellness Benefit
2026 Contributions
ESSENTIAL OPTION
TOTAL MONTHLY CONTRIBUTION (INCLUDES 10% SAVINGS)
BASIC MONTHLY
INCOME (R)
MEMBER
ADULT
DEPENDANT
OVER 21
CHILD
DEPENDANT
UNDER 21
0 - 7 200
R1 699
R1 699
R507
7 201 - 11 100
R1 995
R1 995
R595
11 101 - 14 700
R2 052
R2 052
R611
14 701 - 18 400
R2 119
R2 119
R638
18 401 - 22 000
R2 185
R2 185
R654
22 001 - 25 700
R2 256
R2 256
R677
25 701 - 29 500
R2 346
R2 346
R702
29 501 - 36 900
R2 432
R2 432
R732
36 901 - 44 000
R2 517
R2 517
R760
44 001 - 50 700
R2 608
R2 608
R784
50 701 - 57 500
R2 687
R2 687
R806
57 501+
R2 767
R2 767
R832
2026 Contributions
COMPREHENSIVE OPTION
TOTAL MONTHLY CONTRIBUTION (INCLUDES 10% SAVINGS)
BASIC MONTHLY
INCOME (R)
MEMBER
ADULT
DEPENDANT
OVER 21
CHILD
DEPENDANT
UNDER 21
0 - 7 200
R4 044
R4 044
R1 213
7 201 - 11 100
R4 330
R4 330
R1 304
11 101 - 14 700
R4 422
R4 422
R1 328
14 701 - 18 400
R4 510
R4 510
R1 350
18 401 - 22 000
R4 602
R4 602
R1 389
22 001 - 25 700
R4 706
R4 706
R1 408
25 701 - 29 500
R4 798
R4 798
R1 441
29 501 - 36 900
R4 898
R4 898
R1 467
36 901 - 44 000
R4 984
R4 984
R1 491
44 001 - 50 700
R5 078
R5 078
R1 521
50 701 - 57 500
R5 181
R5 181
R1 549
57 501+
R5 286
R5 286
R1 580
Wellness Benefit
What we cover as part of the Wellness Benefit
Wellness Benefits are provided as additional insured benefits, which do not contribute to the depletion of any other insured limits (or savings) specified elsewhere in these rules. Once the available Wellness Benefits have been used, normal category limits apply.
Note: Except in the case of PMBs, any consultations and costs not specifically stated in this section but related to the specified tests will be paid from relevant day-to-day benefits (or savings).
Know your health status – we cover 100% of the Scheme Rate for a variety of health checks.
Discover All Your Benefits for 2026!
The SABMAS Benefit Guide 2026 is here to help you make the most of your medical aid. From detailed benefit breakdowns to tips on maximizing your coverage, this guide has everything you need.
- Explore New Benefits: Learn about the latest enhancements for 2026
- Save Time & Money: Understand how to efficiently use your medical aid to minimise out-of-pocket expenses
- Plan for the Year Ahead: Be informed and ready for every step of your healthcare journey.
About Prescribed Minimum Benefits (PMBs)
Prescribed Minimum Benefit Conditions
In terms of the Medical Schemes Act, 131 of 1998 and its regulations, all medical schemes must cover the costs related to the diagnosis, treatment and care of:
- Any life-threatening emergency medical condition
- A defined set of 271 diagnosis
- 26 chronic conditions
The cover for the treatment of these conditions is known as the Prescribed Minimum Benefits (PMBs).
All medical schemes in South Africa are obligated to include the Prescribed Minimum Benefits in their health plans. However, members must meet certain requirements before they can benefit from the Prescribed Minimum Benefits.
The three requirements are:
- The medical condition must be part of the list of defined PMB conditions.
- The treatment needed must match the treatments in the defined benefits on the PMB list.
- Members must use Network Providers. However, in the case of life-threatening emergencies this does not necessarily apply.
Additional information about Prescribed Minimum Benefits
Appeal for Out-of-Hospital treatment
PMB Care Baskets
SABMAS Organ Transplant Guide
Out-of-Hospital management of a PMB