How to use Primary Care with your Medical Aid (2025)

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Primary Care insurance, and medical aid

Health insurance can help you save money on your medical costs. It can also help you choose a cheaper medical aid plan (similar to how a gap cover does). If you already have medical aid, you probably only need Primary Care cover from a hospital insurance policy.

Primary Care cover will pay for some of your out of hospital claims, possibly including GP visits, x-rays, blood work, medication and ER visits. You can see a comprehensive list of possible benefits here.

In theory, then, you can choose a medical aid plan without a medical savings account. Instead, you can rely on a health insurance plan to cover your GP costs, medication and x-rays. You will still receive cover from your medical scheme for any PMB related out-of-hospital claims, and – depending on your health insurance plan – might enjoy unlimited GP consults.

Of course, not all your claims are guaranteed to be covered by the insurance policy: for example, you might have to pay out of pocket for specialist consults. You can still opt to use a medical savings account to cover these claims, if you have one, or pay out-of-pocket.

If you can only afford a “hospital only” medical aid, Primary Care health insurance might be a clever way to bridge the gap of unpaid claims, especially for GP and medication costs.


What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions. 

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits. 

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover.