This guide is your central, go-to resource for everything OMSMAF in 2026. No jargon. No panic. Just clear information to help you make the best choice.
Why your annual review matters
We’re all creatures of habit. Once we’ve chosen something, we tend to stick with it — hairstyles, favourite side of the bed, and yes, even medical aid plans. But life is sneaky. It changes in small ways that add up: a new baby, a different medication, a new hobby that involves questionable DIY risks…
Your healthcare needs today may look nothing like they did two or three years ago.
A quick annual review ensures:
- Your cover suits your current lifestyle, not the 2021 version of you
- You’re not paying for unused benefits
- You’re not missing the benefits you need
- Your budget and wellbeing remain on speaking terms
A quick review now is one of the kindest things you can do for your future self.
Understanding OMSMAF’s benefit plans for 2026
Trying to understand medical plans can feel a bit like deciphering ancient hieroglyphics. While we recommend taking the time to carefully review each plan offering before making your choice, we have also put together a clear, concise overview which you can view here.
Let’s talk prevention
If there was a single superpower, we could give every OMSMAF Member, it would be this: use your preventative screenings. They’re free, they’re easy, and they can catch problems long before they become expensive, complicated or worrying.
Shockingly, fewer than 8% of members use their free Preventative Screening Basket, worth R3 500, which is entirely separate from day-to-day benefits. That equates to thousands of missed opportunities to stay healthier for longer.
Available screenings include:
- Health Risk Assessments
- Prostate and breast cancer checks
- Colorectal screening
- Dermatology screenings
- Pap Smears, HPV tests and other women’s health checks
New from 1 April 2026:
- Dermatology screening – Members aged 35+ can now see a Dermatologist once per benefit year.
- Pneumococcal vaccination – Eligible Members will now receive a second lifetime dose from 1 April 2026.
- Women’s health screening – You may now receive one Pap Smear and one HPV PCR test every three years.
Key benefit changes for 2026
Please take careful note of the changes below so that you are fully informed about updates to your current plan and any other plan you are considering moving to.
Network & Network Select Plans: Optical benefits
Members may claim for spectacles every 24 months. To ensure fair benefits for all, the contact lens benefit – which is roughly half the value of the spectacle benefit – is now annual:
- Claim up to R630 every 12 months for contact lenses.
- Or, if you claim spectacles, you must wait the full 24-month cycle before claiming again for either spectacles or contact lenses.
Ultrasound benefit changes for Savings and Traditional / Traditional Select Plans
Ultrasounds are now considered routine radiology and will be paid as standard X-rays under these plans. Ultrasounds will first be paid from the PMSA and then from Primary Care Benefits for the Traditional and Traditional Select Plans.
What remains unchanged
- In-hospital ultrasounds and maternity programme scans remain covered from major medical/risk benefits.
- MRI, CT, and PET scans remain unchanged and continue to be covered under existing benefit limits.
Savings Plan: PMSA Allocation
From 1 April 2026, the PMSA allocation reduces from 16% to 15% of contributions. This small adjustment helps to curb contribution increases.
Traditional and Traditional Select Plans: Benefit structure changes
These plans offer very rich benefits relative to contributions, and at current claims levels, they are becoming unsustainable. To address this, several adjustments have been made.
Special Access
You no longer need a GP referral to visit a Specialist, which will help to curb GP claims. You may now schedule an appointment directly with your Specialist. For urgent issues, please consult your GP if there is a long wait to see the Specialist.
Over-the-Counter (OTC) medication
- Claims are now paid from PMSA only.
- Once PMSA is depleted, OTC medication must be paid out-of-pocket unless accompanied by a script from your doctor.
Hearing aid benefits
- Benefit reduced from R22 700 to R15 000 per ear (10% co-payment still applies), helping to curb costs while remaining a generous benefit.
- Members can use PMSA or self-fund the difference for higher-cost devices.
- Benefit cycles unchanged:
- Available every 3 years for Beneficiaries under 7 or over 85 years
- Available every 5 years for Beneficiaries aged 7–84
Dental implants
- New 20% co-payment introduced
- Annual limit increased to R19 890 per family
- If implants are placed in-hospital, the R1 500 hospital dental co-payment applies in addition to the 20% co-payment.
Inflationary adjustments
A 3.6% inflationary increase has been applied to all benefit sub-limits across all plans, helping to prevent “medical shrinkflation” and reducing the risk of higher out-of-pocket costs.
Contribution increases for 2026/27
OMSMAF’s average weighted increase is 7.9% across all plans. Our income bands will receive an inflationary adjustment.
Traditional Plus Plan
The Traditional Plus Plan will close at the end of this benefit year, and Members will automatically move to the Traditional Plan unless they choose another option by completing a Plan Selection Form here (for Retirees and those without Workday access) or via MyBenefits on Workday (for Active Employees).
- Contributions decrease by 31%
- Slightly lower PMSA and chronic medication limits
- Day-to-day reimbursements under the Primary Care Benefit reduces to 100% of MSR
- All other benefits are unchanged
Traditional and Traditional Select Plans
- Lower income band: 19.9% increase
- Higher income band: 9.9% increase
Plan switch considerations:
Traditional Plan (lower income band) → Traditional Select Plan:
- Same benefits; lower contributions; in-hospital care restricted to Select Network Hospital
- Contribution increase could drop to 8.2%
Traditional Plan (higher income band) → Traditional Select:
- Some Members may see a decrease in contributions
- Ensure a Select Network Hospital is conveniently located near to you for all in-hospital care
Savings Plan
- PMSA allocation will be reduced from 16% to 15% to ease contribution pressure
- 7.9% increase across all income bands
Who should consider switching to the Savings Plan:
- Members in the new, higher income band (R50,001+) on Network or Network Select Plans
- Traditional Select Members in the lowest income band who want lower contributions and more Provider flexibility
Hospital Plan
7.9% increase across all income bands
Network and Network Select Plans
Six income bands are available, with a new income band added for earners above R50,001/month.
Contribution increases:
- New top income band: 10.9%
- Lowest two income bands (< R9, 520): 6.9%
- All other bands: 7.9%
Switch considerations:
- Moving from Network to Network Select can reduce increases or even lower contributions for some Members.
- Members in the new highest income band may find the Savings Plan more cost-effective and flexible.
Making your final decision
Choosing a benefit plan is a balance between your healthcare needs and your budget. As you review your options, consider how often you use healthcare, any major life events coming up, whether you’re comfortable using Network Providers, and whether preventative care could help you avoid future costs.
Give yourself plenty of time before the 6 March submission deadline. Our Client Liaison Officers are here to help guide you. Book a one-on-one appointment as soon as possible, click here to book.
Your health is precious. Your budget is too. With the right OMSMAF plan, you’re looking after both.
Here’s to a healthier, happier, and better-covered 2026.