How to read a health insurance quote: what does each line mean?
Compare Health Insurance is a comparison website and does not give financial advice. Quote requests made through this site are handled by our advice partner, Curemed (Pty) Ltd, FSP 44098, an authorised financial services provider. We compare only products available through our advice partner, so this comparison is not independent of it. Every figure is from the named public source on the stated date.
A health insurance quote shows a separate monthly premium for the main member, each adult dependant and each child, the option and any add-on chosen, and the rules that decide whether a claim is paid: the network you must use, the medicine list, the yearly limits and the waiting periods. It should also name the insurer that carries the risk, and it must state that the policy is not a medical scheme. This guide explains each line using the 2026 documents for the plans we compare.
In short
- Premiums are priced per person. On Flexicare Core one adult and one child cost R745 a month before any add-on.
- Most claims are paid only at network providers and only for medicine on the insurer's list.
- Waiting periods apply from the start date. Discovery lists them; Momentum says they apply but does not list their length in its 2026 brochure.
- Premiums are reviewed every year. Momentum's 2025 company application form says employer rates take effect on 1 January.
This is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.
Which lines appear on a health insurance quote?
| Line on the quote | What it means | Example from the plans we compare |
|---|---|---|
| Product and option | The plan and benefit level you are buying | Discovery Flexicare Core or Plus; Momentum Health4Me Bronze, Silver or Gold |
| Main member (principal) premium | The monthly price for the person who takes out the policy | Flexicare Core R459, Flexicare Plus R539, Health4Me Bronze R709 |
| Adult dependant premium | The price for each spouse or other adult on the policy | Flexicare Plus R499 per adult |
| Child premium | The price for each child. Each child is charged separately | Flexicare R286 per child, with the adult rate from the month after the 21st birthday; Health4Me Bronze R423 per child |
| Add-on | Optional cover for emergencies and hospital events, priced per person | Discovery Emergency Cover with a limit of R400,000 or R1 million; Health4Me Base or Standard major medical event benefit |
| Waiting periods | Periods after the start date when you cannot claim for certain benefits | Flexicare: 1 month general waiting period on all benefits |
| Underwriter | The licensed insurer that carries the risk and pays claims | Flexicare: Auto and General Insurance Company Limited (an authorised non-life insurer). Health4Me: Momentum Metropolitan Life Limited (FSP 6406) |
| Administrator | The company that runs membership and claims for the insurer | Flexicare: Discovery Health (Pty) Ltd. Health4Me: Momentum Health |
| Not-a-medical-scheme statement | A statement the Demarcation Regulations require on health insurance marketing | See the wording above this table |
| Advisor and FSP number | Who gives the advice, and the licence they hold | Curemed (Pty) Ltd, FSP 44098 |
What does a family quote add up to?
Health insurance has no single family price. The quote adds up a premium for each person. A worked example using published 2026 premiums for one adult and one child:
| Line | Monthly premium |
|---|---|
| Flexicare Core, main member | R459 |
| Flexicare Core, child | R286 |
| Emergency Core, main member | R218 |
| Emergency Core, child | R92 |
| Total | R1,055 |
Discovery states that if Emergency Cover is chosen, it applies to the member and registered dependants on the Flexicare policy, so each person on the policy carries an Emergency Cover premium.
What do "network GP" and "formulary medicine" mean on a quote?
- Network GP: the plan pays only for doctors on its network. Discovery states that Flexicare does not cover non-network doctor consultations, that a network doctor is allocated when the first claim for a consultation is received, and that you can change your chosen doctor 2 times a year. Health4Me members use Momentum network GPs, dentists and optometrists.
- Formulary medicine: the formulary is the insurer's list of approved medicines. Discovery's 2026 brochure states that acute medicine is covered only if it is on the list, prescribed by a network doctor, and dispensed by that doctor or by a network pharmacy. Momentum provides acute medicine "in accordance with the Network prescribed acute medication formulary".
Which limits should I look for?
Health insurance pays up to set limits, per member or per family, per visit, per event or per year. If treatment costs more, you pay the difference. Two examples from the plans we compare:
- Flexicare Plus specialist cover: 1 out-of-hospital specialist consultation per member per year, up to R2,090 including related x-rays or blood tests.
- Health4Me Gold specialist cover: Up to 2 visits a year, limited to R1,425 a visit and R2,850 per member or family a year, on GP referral and pre-authorisation.
For emergency add-ons, check the limit per event and per year. Discovery Emergency Cover is sold with a limit of R400,000 or R1 million. The Health4Me Base and Standard benefits have different per-event and yearly limits, set out on our Health4Me page.
What do the waiting period notes mean?
A waiting period is a time after your start date when you cannot claim for a benefit. Discovery lists these for Flexicare: 1 month general waiting period on all benefits; 3 months for dentistry and optometry; 12 months for maternity, HIV and chronic conditions; A 12 month condition-specific waiting period may apply to any condition that existed before joining. For Health4Me, Momentum's 2026 brochure says only that waiting periods apply to several benefits. Read our guide to health insurance waiting periods for a product-by-product table.
When can the premium on a quote change?
| Item | Discovery Flexicare | Momentum Health4Me |
|---|---|---|
| Review | Terms, services and benefits may be reviewed and updated every year (terms, clause 7.4) | Premiums are reviewed annually (2026 brochure). For employer groups, new rates take effect on 1 January each year (2025 company application form) |
| VAT | Amounts payable include VAT (terms, clause 6) | Premiums are exempt from VAT (2026 brochure) |
| Debit order | Collected on the first working day of the month, unless you choose another day (debit order mandate) | Not stated in the 2026 individual brochure |
| Ending the policy | One month of notice (terms, clause 9.1.2) | Not stated in the 2026 individual brochure. Employer groups give one calendar month of notice (2025 company application form) |
| Commission | Maximum commission is up to 20% of the monthly premium, for as long as the policy is active (terms) | Not stated in the 2026 individual brochure |
This site shows 2026 premiums. We check every figure each month and will replace them once the insurers apply their 2027 premiums.
What should I ask the Advisor before accepting a quote?
- Which insurer underwrites this policy, and which company administers it?
- What is the premium for each person on the quote, and what is the total?
- Which waiting periods apply to each person, and how long is each one? Please confirm them in writing.
- Which network GPs, dentists and optometrists are near my home or work?
- What are the yearly limits for each benefit, and what is not covered?
- Does the plan cover any hospital treatment? If only through an add-on, what is the limit per event?
- When is the next premium review, and how will I be told about a change?
- How much commission does the Advisor earn on this policy?
How can I check this myself?
- Open the insurer's product page or brochure listed under Sources and compare each premium on your quote with the published table for the same option and year.
- Find the underwriter statement at the foot of the product page or brochure and check it matches the quote. Our underwriter guide lists each one.
- Check the waiting period table in the brochure, and ask for anything the brochure does not list.
- Search the Advisor's financial services provider number on the FSCA register.
- Check that the quote carries the not-a-medical-scheme statement shown above.
Common questions
Why is the adult dependant premium sometimes lower than the main member premium?
Each insurer sets its own rates per person. On Flexicare Plus the main member pays R539 and each adult dependant pays R499 a month. On Flexicare Core both pay R459.
Does a quote mean I am covered from the first day?
No. Waiting periods start on the day cover starts. Discovery applies a 1 month general waiting period on all Flexicare benefits, and longer waiting periods for some benefits. Momentum states that waiting periods apply to several Health4Me benefits but does not list their length in its 2026 brochure.
Can the premium on my quote change after I join?
Yes. Discovery reserves the right to review Flexicare terms, services and benefits every year, and Momentum states that Health4Me premiums are reviewed annually. We check every figure each month and will replace the 2026 premiums once the insurers apply their 2027 premiums.
Who prepares the quote?
Quote requests made through this site go to our advice partner, Curemed (Pty) Ltd, FSP 44098. A Curemed Advisor prepares the quote and gives the advice. This website does not give financial advice.
Sources
- Discovery, Flexicare product page (premiums, FAQ, network doctor rules, underwriter statement), read 22 October 2026
- Discovery, Terms of the Flexicare product (individual and household): clauses 6, 7.4 and 9.1, debit order mandate and commission note, read 22 October 2026
- Discovery, 2026 Flexicare benefit brochure (waiting periods, newborns, breaks in cover), read 22 October 2026
- Discovery, 2026 Flexicare employer brochure (medicine list and network rules), read 22 October 2026
- Momentum, Health4Me for Individuals brochure 2026 (premiums, annual review, VAT, underwriter statement), read 22 October 2026
- Momentum, Health4Me company application form, 2025 version (rates effective from 1 January each year), read 22 October 2026
- Long-term Insurance Act Demarcation Regulations, regulation 7.5 (Acts Online), read 22 October 2026