Laura du Preez | 03 June 2025
Laura du Preez has been writing about personal finance topics for more than 20 years, including eight years as personal finance editor for two leading media houses.
Medical scheme members who are supporting adult children registered on their medical scheme should review their cover, as there may be more cost-effective ways to cover young adults.
But healthcare advisers warn that you should also be aware of consequences of moving one family member to an option in their own name.
From the age of 18, your children are adults and can belong to a medical scheme in their own right. However, most medical schemes allow you to keep your adult children who are still dependent on you on your scheme option at discounted child dependant contribution rates until the age of 21.
This may be cost-effective as there can be a considerable difference between the child contribution rate and the adult dependant rate depending on the option, Zee Gumede, senior healthcare consultant at GTC Healthcare, says.
However, it depends on the scheme option to which you belong, as there are medical scheme options that charge the same contribution for all the members, young or old, she says.
As an example of how big the gap is between the child dependant rate and the adult dependant rate, Gumede said there is a R6 939 a month difference between the contributions on a comprehensive plan on the biggest scheme in South Africa. The adult dependant rate is R8 793 a month, while the child dependant rate is R1 856 a month.
Victor Crouser, healthcare adviser and founder of SecureMyFuture, says on lower options he has seen parents save R2 000 a month just by having an adult child remain on child dependant rates rather than pay adult rates.
After your adult child turns 21, most medical schemes will change the child dependant 
rates they were charging to adult dependant rates, both Gumede and Crouser say.
Some medical schemes will continue to charge child rates for adult children over the age of 21 depending on certain factors, they say. These factors include:
Crouser says some schemes are looking to attract younger members and market the fact that adult children can remain on the scheme at child dependant rates until higher ages, such as age 24, 26 or even 27 if the adult child meets certain criteria, such as earning less than the social old age grant, he says.
Another factor to consider and how it may affect your budget is that some employers who assist employees with a medical scheme subsidy, will subsidise an adult child but not after the age of 21, Gumede says.
Gumede says most schemes charge adult dependant rates for adult children after the age of 21 because actuaries and other professionals who monitor claims experience in 
the insurance and medical scheme industries have found that claiming patterns change from this age.
Young adults, for example, have a higher risk of being involved in motor vehicle accidents which is why insurers tend to charge higher rates when insuring vehicles driven by young adults.
Schemes take this and other claims experiences into account when they project the utilisation of benefits, how this will affect the scheme’s budget and what rates adult children should pay, Gumede says.
A review is a good idea when an adult child reaches specific milestones, Gumede says.
If your adult child has reached the age where your scheme charges adult medical scheme rates, but your child is healthy and claiming medical scheme benefits infrequently, you could consider a more cost-effective medical scheme option for them, she says.
Crouser says you should ask a healthcare broker to review your circumstances annually and to make you aware of what will happen when your adult child is due to turn 21.
There are entry level plans with contributions based on income which may benefit adult children who are not earning or only earning an entry level income, Gumede says.
Some schemes have options tailored particularly for foreign students attending tertiary education institutions in South Africa. Crouser says one of these has 2025 contribution rates as low as R589 for a member with an income of between R0 and R1 500 a month.
Hospital plans, which cover hospitalisation, clinical emergencies and the prescribed minimum benefits (PMBs) may be an option and both Gumede and Crouser suggest that options, which target young, healthy people – often with telemedicine – but provide major medical benefits and PMB cover in private facilities, may also be suitable for students. The contributions on these options are between R1 000 and R1 400 a month.
The risk of downgrading your healthy adult child to a cheaper medical scheme option is that the less you pay in contributions, the less you receive in benefits, Gumede says.
Before you downgrade your adult child’s cover to a cheaper option, check if it is one that offers cover only in the specified networks of hospitals, doctors, pharmacies and other healthcare providers.
These network options are likely to be more restrictive in terms of choice of healthcare providers you can use than a higher option to which the family currently belongs and you need to understand the restrictions on access, the suitability and accessibility of these networks and the option rules, Crouser says.
Also consider whether the rates or tariffs at which providers are reimbursed is lower on the cheaper option.
Check particularly that you are comfortable with the lower limits on certain benefits, such as oncology or for prostheses, she says.
Consider your adult child’s current chronic conditions and pre-existing conditions when you decide how to cover their health care, as some medical scheme options cover the prescribed minimum benefits (PMBs) only and others cover additional conditions over and above the 27 chronic conditions listed as PMB’s, Gumede says.
Not only could the young adult have less in benefits, you may also lose the benefit of pooling benefits as a family, which could result in less day-to-day healthcare benefits for those who remain on the higher option.
Crouser says you can only really assess the risks with the help of a healthcare broker who can conduct a needs analysis for you and explain the option benefits. The risks of moving a young adult to their own option will depend on the family members’ current health and needs, as well as possible future health requirements and circumstances.
If the adult child suffers from a chronic condition or ill health, they may need a higher option and moving them to an option in their own name may not achieve any cost savings, Crouser says.
If you move your adult child dependant to an option in their own name, consider taking out gap cover to cover shortfalls on in-hospital treatment, he says. Gap cover can be obtained for around R170 a month and can provide higher rates of reimbursement for professionals who treat you in hospital than your scheme.
For example, parents may be on an option that provides cover for doctors who treat you in hospital at 300 percent of the scheme rate, whereas a lower option may only cover at 100 percent of scheme rate. Gap cover can make up the difference if your young adult is admitted to hospital and seen by a doctor who charges more than the scheme rate, Crouser says.
If you are considering switching your young adult to an option on a different medical scheme, be sure to check if any waiting periods that may apply before you switch, Crouser warns.
