Cape Medical Plan

Both options cover the statutory Prescribed Minimum Benefits: about 270 medical conditions, 29 chronic conditions and all genuine emergency medical conditions, in CMP's own description. PMBs are paid from the risk benefit, never from your savings account, and the brochures repeatedly use the phrase "except for PMBs" to mark the point where a limit stops applying.

Three conditions attach to that cover:

• PMB treatment must conform to CMP's formularies and protocols, and the correct ICD-10 and PMB codes must be on the claim. A missing code is the most common reason a legitimate PMB claim is paid as an ordinary claim.
• Services must be obtained from a Preferred Provider, or involuntarily obtained from another provider. The brochures make this subject to pre-authorisation and to rules 18.9 and 18.10 of the MyHealth 100 Saver benefit set, and rules 17.9 and 17.10 on MyHealth 200.
• CMP reserves the right to investigate every PMB claim and to ask for supporting documentation.

Where the numbers disagree

CMP's own documents give three different chronic condition counts. The 2026 brochures say 29 chronic conditions in the PMB definition, then print a Chronic Disease List with 28 named entries. The scheme's chronic cover page says 33 eligible conditions, of which 8 need a specialist prescription. Its Prescribed Minimum Benefits page says 25. Ask CMP which list governs your condition before you rely on the benefit.

The CMP tariff itself is the maximum CMP will pay a provider on your behalf. It is not a published fee schedule you can look up, and it is not linked to the Agreed Tariffs CMP has with the hospital groups. When a provider charges above it, the difference is a payment shortfall, and a payment shortfall is not the same thing as a co-payment: a co-payment is a fixed amount CMP has told you about in advance, a shortfall is whatever the provider decided to charge.

Chronic medicine is covered identically on both options: 100% of cost, to a maximum of the Single Exit Price, plus the agreed Preferred Provider dispensing fee. There is no rand cap on the chronic benefit published in either brochure. Access is subject to registration and authorisation.

The 28 conditions named on the 2026 Chronic Disease List are Addison's disease, anti-coagulation therapy, asthma, bipolar mood disorder, bronchiectasis, cardiac failure, cardiomyopathy, chronic obstructive pulmonary disease, chronic renal disease, coronary artery disease, Crohn's disease, Cushing's disease, diabetes insipidus, diabetes mellitus types 1 and 2, dysrhythmias, epilepsy, glaucoma, haemophilia, HIV, hyperlipidaemia, hypertension, hypothyroidism, rheumatoid arthritis and juvenile rheumatoid arthritis, multiple sclerosis, Parkinson's disease, schizophrenia, systemic lupus erythematosus and ulcerative colitis.

How to register

Your prescribing doctor registers the condition by phoning CMP's Customer Care on 021 937 8300, emailing chronic@cmp.co.za, or phoning Swift Online on 0800 132 345, quoting the ICD-10 code. No application form is required. Cover does not start until the condition is registered.

The formulary

CMP uses a Condition Medicine List rather than a fixed product list, and revises it continuously for new registrations, discontinuations and price changes. Some conditions have severity-tiered drug lists with clinical criteria gates, and eight conditions require a specialist rather than a GP to prescribe. Vitamins, homeopathic products, hypnotics, mucolytics, most antibiotics and muscle relaxants are outside the formulary. Ask for the current list for your specific condition when you register, so you know whether your existing prescription is on it.

HIV is on the Chronic Disease List and is funded through this benefit. CMP publishes no separate named HIV disease management programme.

MyHealth 100 Saver members contribute to a compulsory savings account through the monthly contribution. For 2026 it is R4 560 an adult and R720 a minor beneficiary a year.

• The full year's amount, equal to twelve monthly savings contributions, is pre-funded at the start of the year rather than accumulating month by month. You can spend all of it in January.
• It accrues interest.
• It may not be used to pay PMBs or to offset your contributions.
• If you leave CMP mid-year having already spent the full pre-funded amount, CMP claims back the portion of savings owing for the rest of the year. That is a real debt, and it is the reason to think twice before switching schemes in October after a heavy year.
• If you transfer to or from another scheme, unused savings transfer with you. If you die, the balance goes to your estate.
• Join after 1 January and both the savings account and the built-in day-to-day benefits are pro-rated to the number of contributions you will pay that year.

At R4 560 a year for an adult, the savings account is about 10% of what an adult pays in over the year. Unused savings carry over to the next year. Unused built-in day-to-day benefits do not.

MyHealth 100 Saver has a short list of fixed, built-in day-to-day benefits that are paid before your savings account is touched. When they run out, spending shifts to the savings account, and when that is empty you pay for yourself except for PMBs. MyHealth 200 has one GP visit a year and nothing else.

CMP does not run a maternity programme in the way larger schemes do. What it publishes is a set of limits.

• Confinement is covered at 100% of the CMP tariff on MyHealth 100 Saver and 200% on MyHealth 200. Both brochures state that only medically necessary caesareans are covered. An elective caesarean by choice is not a covered benefit, PMB rules aside.
• Antenatal consultations and foetal scans, in or out of hospital, are limited to R3 065 a family a year on both options, and must come from a registered gynaecological or radiology practice. On MyHealth 100 Saver, spending above that shifts to the savings account. On MyHealth 200 there is nothing above it except PMBs.
• Paediatrician consultations are R1 224 a child a year on MyHealth 100 Saver and R2 595 a child a year on MyHealth 200. The option with no day-to-day cover has the better paediatric benefit, which is counter-intuitive and worth knowing if you are choosing an option with a newborn in mind. Paediatrician procedures and operations are covered at tariff on both.
• One gynaecologist visit a year per female beneficiary is a built-in benefit on MyHealth 100 Saver. MyHealth 200 has no separate gynaecology benefit outside the antenatal limit.
• Childhood vaccinations for minors aged 12 and under are limited to R1 039 a minor a year, to the maximum of the Single Exit Price, on MyHealth 100 Saver only. MyHealth 200 has no vaccination benefit.

Infertility treatment is excluded on both options unless it is authorised within PMB level of care criteria. There is no assisted reproduction benefit, no published neonatal programme and no doula, midwife or postnatal class benefit.

Cancer cover on both 2026 options is identical and it is delivered as a PMB, not as a rand-limited benefit of the scheme's own.

• Treatment is covered at 100% of the CMP tariff, to the SA Oncology Consortium Primary Level of Care treatment guidelines, provided CMP's formularies and treatment protocols and the SAOC tier guidelines are applied under an agreed treatment plan.
• Pre-authorisation is required.
• No rand limit is published for oncology on either option, and neither is any rule for biological, immunotherapy or other specialised cancer medicines. Their absence from the brochures does not mean they are unlimited. It means the limit lives in the registered Scheme Rules and the SAOC tier you are placed on.
• Anti-emetics, vitamins, and cosmetic and prosthetic appliances forming part of cancer treatment are payable from the savings account on MyHealth 100 Saver and have no cover except PMBs on MyHealth 200. Wigs and post-mastectomy prostheses fall here.
• Mammaprint genetic testing, and any other genetic testing, is an explicit exclusion on both options.

Neither 2026 option has a mental health benefit worth the name. What exists is the statutory minimum and, on MyHealth 100 Saver, your own savings.

• Hospitalisation or institutionalisation for mental illness, alcoholism and drug addiction is payable from the savings account on MyHealth 100 Saver, except for PMBs, and has no cover except for PMBs on MyHealth 200.
• Non-PMB psychological and psychiatric treatment, including sleep studies, is an explicit exclusion on both options.
• Non-PMB treatment relating to alcohol or substance abuse, wilful self-injury or attempted suicide is excluded on both options.
• Educational and group therapy is excluded on both options.
• Psychiatrists and psychologists are classed under supplementary services, not specialists. That means out-of-hospital consultations come from the savings account on MyHealth 100 Saver and have no cover except PMBs on MyHealth 200. In hospital, supplementary services need separate authorisation.

In practice that leaves you with the PMB list: bipolar mood disorder and schizophrenia are on the Chronic Disease List for medicine, and the PMB regulations cover a defined number of in-hospital days and out-patient contacts for certain diagnoses. Everything outside that is either your savings account or your own money. If anyone in the household is in therapy, or likely to need it, price that in before you buy either option.

Dental work on both options is covered only as set out in the CMP Dental Protocol, which the scheme does not publish. Ask for it.

Three things are worth spelling out. First, adults get no optometry benefit at all on either option: the R520 consultation benefit on MyHealth 100 Saver is for minor beneficiaries only, and adult eye tests, spectacles and lenses come from the savings account. Second, dental implants, orthodontic, prosthodontic, periodontic and orthognathic treatment are all named in the general exclusions on both options, so on MyHealth 100 Saver they are payable from savings only because the exclusions list allows savings to pay for excluded items, not because they are a benefit. Third, general dentistry under general anaesthetic or conscious sedation is excluded for minors over the age of 7 on both options, which catches a common reason for taking a nervous child to a dental theatre.

Refractive eye surgery, including LASIK and excimer laser, and blepharoplasty, are excluded on both options.

Advanced imaging is the tightest limit on both options and it carries a co-payment on top of the limit.

A single MRI can absorb most of the R16 027 annual imaging limit on its own, and the R1 700 co-payment applies to every event, not once a year. A written referral is required for the advanced imaging benefit and for scopes, and pre-authorisation is required for CT, MRI and radio-isotope scans.

Preventative screening CMP pays for

That is the entire published preventative benefit. There is no Pap smear benefit, no PSA prostate test benefit, no flu vaccine, no HIV screening benefit, no annual health check and no wellness or rewards programme published on either option. Both must be done at a registered radiology practice. Note the ages: mammograms start only once a woman is over 44, and at two-yearly intervals, which is later and less frequent than most screening guidance.

Internal prostheses and implants introduced as an integral part of an operation are covered at 100% of cost, limited to R58 743 a beneficiary a year on both options, and must be authorised. Hearing devices and dental implants are excluded from this benefit and from the scheme generally. Within the annual limit, individual devices carry their own sub-limits.

Two cardiac stents in one admission takes R36 714 of the R58 743 annual limit, and a pacemaker or a single joint replacement takes all of it. Bilateral joint replacement is the one item allowed to breach the annual figure, at exactly double.

On MyHealth 100 Saver, hip and knee replacement is only covered if it qualifies as a PMB, so the joint replacement sub-limit is largely academic on that option. Chronic renal dialysis and organ transplants are covered on both options at 100% of the CMP tariff, but only where PMB level of care criteria are met. Treatment relating to organ transplants that falls outside PMB level of care is an explicit exclusion.

These exclusions apply across both options and can never be paid from insured benefits, subject to PMB rules. On MyHealth 100 Saver they may be paid from the savings account if there is money in it. On MyHealth 200 there is no savings account to pay them from.

• COVID-19 testing for travel or leisure purposes.
• Blepharoplasty and any procedure to correct eye refraction errors, including excimer laser and LASIK.
• Treatment for sexual dysfunction, male and female.
• Infertility treatment, unless authorised within PMB level of care criteria.
• Breast reductions including scar revision, Botox, breast augmentation and gynaecomastia. Non-diseased breast reconstruction, nipple reconstruction and symmetry, unless authorised within PMB level of care criteria.
• Mammaprint genetic testing and any other type of genetic testing.
• Any cosmetic surgery, and treatment or surgery for obesity.
• Long-term nursing care, such as frail care nursing.
• Non-PMB treatment relating to alcohol or substance abuse, wilful self-injury or attempted suicide.
• Non-PMB psychological and psychiatric treatment, including sleep studies. Educational and group therapy.
• Protective gear.
• Treatment relating to organ transplants that falls outside PMB level of care criteria.
• Non-PMB external devices, specifically including crutches, commodes, nebulisers, pronator boots, bed pans, raised toilet seats, wheelchairs and CPAP machines.
• Non-PMB hearing devices and cochlear implants, and their maintenance.
• Artificial and synthetic blood products.
• Dental implants, orthodontic treatment, prosthodontic treatment, orthognathic procedures and periodontic treatment. General dentistry under general anaesthetic or conscious sedation for minors over 7.
• Experimental or unproven treatments, procedures and devices, unregistered medicines and Section 21 medicines.
• Household medicinal remedies, contraceptives, patent medicines and proprietary preparations, including vitamins, supplements, minerals, medical creams, soaps, shampoos and laxatives.
• Medical examinations for insurance, school, association, emigration, visa or employment applications.
• Deep brain implants, and internal nerve pain stimulators, temporary or permanent, for medical and surgical conditions.
• Any treatments or costs not specifically provided for.
• On MyHealth 100 Saver only: hip and knee replacements are limited to PMBs.

Two things to note. Contraceptives are excluded on both options, which is unusual and worth knowing. And "any treatments or costs not specifically provided for" is a closed-list clause: if a benefit is not named in the brochure, assume it is not covered rather than assuming it is. No international travel or overseas treatment benefit is published on either option. Buy separate travel insurance before you fly.

Neither is published by the scheme. The 2026 brochures say nothing about general waiting periods, condition-specific waiting periods or late-joiner penalties, and neither does the scheme's public website. Broker mirrors quote the standard statutory positions of three and twelve months, but that is a mirror repeating the law, not CMP stating its own practice.

What the Medical Schemes Act allows an open scheme to apply:

• A general waiting period of up to 3 months, during which you pay contributions but cannot claim, except for certain PMBs.
• A condition-specific waiting period of up to 12 months on a pre-existing condition, where you had less than two years of continuous prior cover.
• A permanent late-joiner penalty from age 35 where you cannot show sufficient prior South African scheme membership.

If CMP applies the statutory maximum late-joiner bands, this is what they would add to a 2026 adult contribution. The scheme has not confirmed that it applies them, or at what level, so treat the table as the legal ceiling rather than as CMP's published practice.

1. Complete the membership application form from the scheme's forms page and email it to sales@cmp.co.za. If you are moving from another scheme, use the Transfer Application form instead.
2. Adding a dependant later uses a separate Dependant Application Form, and changing your bank details uses a Change of Banking Details Form. Both are downloads on the same page.
3. A "Request a Callback" form on the site puts you in touch with the group relations and sales consultant if you want help choosing between the two options.
4. The supporting documents CMP requires, and its underwriting questionnaire, are not published. Expect to supply identity documents, banking details and a certificate of membership from your previous scheme.

Join after 1 January and everything out of hospital is pro-rated. Both the built-in day-to-day benefits and the savings account are reduced in proportion to the number of contributions you will pay for the rest of the year. Hospital cover is not pro-rated.

Authorisation runs through 021 937 8300 or WhatsApp text to 079 298 5548, Monday to Friday in office hours. Get it before you go, not after.

• What needs pre-authorisation: every planned hospital admission; procedures done in a doctor's rooms that would normally need hospitalisation; CT, MRI and radio-isotope scans; renal dialysis; oncology treatment; hospice, nursing and step-down care; chronic medication; supplementary services in hospital; any procedure performed by a GP; and any treatment beyond what was originally authorised.
• Emergency admissions still need authorisation, requested within 72 hours of the incident. A friend or family member may do it for you.
• Emergency road transport must be authorised within 72 hours of the event, by a registered service provider. Airlifting must be pre-authorised before take-off, with proof of a life-threatening emergency, which in a genuine emergency is a difficult condition to meet.
• The penalty for failing to pre-authorise is not published. Ask.

• All claims must be submitted within four months of the date of treatment. This is a hard deadline and it is shorter than some schemes allow.
• The service provider must have an active Board of Healthcare Funders practice number for you to be reimbursed. A practitioner without one cannot be paid, however well qualified.
• CMP states on its website that claims are settled within two weeks. That is the scheme's own claim, not a published service standard in the brochures.
• CMP will pay benefits directly to you if you ask, but says it does so at its discretion.
• If an account looks invalid CMP may scrutinise it, refer it to the Health Professions Council of South Africa, and withhold payment of that claim until the grievance is resolved.
• Pharmacy claims are switched through MediKredit.

CMP publishes a three-stage process. Work through it in order, because the Council will ask whether you have.

1. Internal complaint. Write to The Principal Officer, Complaints Division, P.O. Box 6255, Welgemoed 7538, or email complaints@cmp.co.za. CMP undertakes to respond within 30 days.
2. Disputes Committee. If you are not satisfied, escalate to the Chairman of the Disputes Committee within 60 days. Miss that window and you lose the internal appeal.
3. Council for Medical Schemes. Complaints Unit, Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Centurion 0157, or Private Bag X34, Hatfield 0028. Sharecall 0861 123 267, fax 086 673 2466, email complaints@medicalschemes.co.za. From there the route runs to the CMS Appeal Committee, the Appeal Board and ultimately the High Court.

You may approach the Council at any stage. You do not need CMP's permission to do so.

Any hospital in the Life Healthcare, Mediclinic or Netcare groups, anywhere in South Africa, with any doctor or specialist you choose. CMP has negotiated fixed Agreed Tariffs with those three groups. There are a few hospitals outside them, and there your claim is paid only at the CMP tariff, which the brochures warn "may result in payment shortfalls". There is no fixed penalty for going outside, but there is no cap on the shortfall either. Every admission needs pre-authorisation from 021 937 8300 first.

The number is the tariff multiple for doctors in hospital. MyHealth 100 Saver pays GPs and specialists in hospital at 100% of the CMP tariff and gives you a savings account of R4 560 an adult plus a short list of built-in day-to-day benefits. MyHealth 200 pays them at 200%, covers joint replacements outside PMB rules and pays confinement at double tariff, but has no savings account and one GP visit a year. It costs R168 more a month for an adult. Over a year, for a family of four, choosing MyHealth 200 costs R7 032 more in contributions and gives up R10 560 of savings account.

CMP does not announce a contribution increase. Comparing its own 2025 and 2026 brochures, the adult rate on MyHealth 100 Saver went from R3 447 to R3 706, an increase of 7.5%, and MyHealth 200 went from R3 577 to R3 874, an increase of 8.3%. Do not confuse either with the 3.9% figure printed in the brochures. That is the tariff escalation, meaning the rate CMP reimburses providers at, and it rose at roughly half the rate your contribution did.

Barely. MyHealth 100 Saver gives you two GP visits an adult and four a minor beneficiary each year at 100% of the CMP tariff, after which GP visits come out of your savings account. MyHealth 200 gives you one GP consultation per beneficiary per year and nothing after that. Any procedure performed by a GP, on either option, needs pre-authorisation first.

Yes, in writing, where hospitalisation or a procedure is involved. CMP requires a written motivation from a GP or family physician that says why you are being referred, what conservative treatment has already been tried and what your recent medical history is. It is a scheme rule, not a suggestion. You may then see any specialist you like, but note that both brochures name the specialist disciplines they cover, and that list does not name oncologists, adult cardiologists, nephrologists, rheumatologists or endocrinologists by those titles. If your referral is to a discipline that is not named, get cover confirmed in writing first.

Yes. Nothing in the scheme's rules restricts membership by province, and Life, Mediclinic, Netcare, PathCare, Lancet, Clicks and Medipost all operate nationally, so your benefits work the same in Durban as in Durbanville. What you give up is service. There is one office, in Tygervalley, with no branches elsewhere, no mobile app, no find-a-provider tool, a Cape Town landline rather than a national sharecall number, office hours of 08:00 to 17:00 on weekdays only, and no published after-hours clinical or ambulance line. If you want to be able to walk into a branch or phone someone on a Sunday, this is not the scheme.

The CMP tariff is the maximum amount CMP will pay a provider on your behalf. CMP sets it itself, and for 2026 it is the 2025 tariff plus 3.9%. Every benefit on both options is a percentage of it. If your surgeon charges more than CMP pays, the difference is a payment shortfall and it is yours, with no cap. A payment shortfall is not the same as a co-payment: a co-payment is a fixed amount CMP tells you about in advance, like the R1 500 per scope or R1 700 per scan. Before an elective admission, ask the surgeon and the anaesthetist what percentage of medical aid rate they bill at.

Yes, as a Prescribed Minimum Benefit, at 100% of the CMP tariff to the SA Oncology Consortium's Primary Level of Care treatment guidelines, on both options. Treatment must follow CMP's formularies and protocols under an agreed treatment plan, and must be pre-authorised. No rand limit is published, and no rule for biological or immunotherapy medicines is published either. Anti-emetics, vitamins and prosthetic or cosmetic appliances forming part of cancer treatment come out of your savings account on MyHealth 100 Saver and are not covered outside PMBs on MyHealth 200. Genetic testing, including Mammaprint, is excluded on both.

They are CMP's designated pathology providers and both are SANAS-accredited. On MyHealth 200, out-of-hospital pathology at any other laboratory is entirely for your own account. On MyHealth 100 Saver, out-of-hospital pathology at those two is covered to R5 195 a family a year. In hospital, a pathologist from any other laboratory is covered only during the first 24 hours of an emergency admission, only with CMP's approval, and only if SANAS-accredited. Check which laboratory your doctor's practice uses before your blood is drawn, not afterwards.

Not outside the Prescribed Minimum Benefits. Non-PMB psychological and psychiatric treatment, including sleep studies, is an explicit exclusion on both options. Hospital admission for mental illness, alcoholism or drug addiction comes from your savings account on MyHealth 100 Saver, which for a single adult is R4 560 for the whole year, and has no cover except PMBs on MyHealth 200. Psychiatrists and psychologists are classed as supplementary services rather than specialists. Bipolar mood disorder and schizophrenia are on the chronic list for medicine. This is the weakest part of both options.

A third option with a live product page on CMP's website, describing in-hospital and out-of-hospital cover plus a savings account, and with better cancer cover than the other two: the scheme's oncology page gives it SA Oncology Consortium Standard Level of Care for curative treatment, against Primary Level of Care on the other two. But it is not in the site navigation, there is no 2026 brochure for it, its 2026 contribution is not published, and the scheme's terms and PMB pages list only the two options. Treat it as unavailable unless CMP confirms otherwise on the phone.

Three stages. Write to The Principal Officer, Complaints Division, P.O. Box 6255, Welgemoed 7538, or email complaints@cmp.co.za. CMP undertakes to respond within 30 days. If that does not resolve it, escalate to the Chairman of the Disputes Committee within 60 days, and do not miss that window. From there, take it to the Council for Medical Schemes on 0861 123 267 or complaints@medicalschemes.co.za, and after that to the CMS Appeal Committee, the Appeal Board and ultimately the High Court. You may approach the Council at any stage without CMP's permission.