Monthly premium, per family
By age band, as Turnberry publishes it. 2027 premiums take effect on 1 January 2027.
| Age | 2026 | 2027 | Change |
|---|---|---|---|
| 0 to 64 | R558 | R600 | +7.5% |
| 65 and older | R806 | R870 | +7.9% |
What it covers
What it pays
Limits and joining
Who is covered
In Turnberry’s own words.
- The Principal Insured person; Their Spouse (a spouse may be on a different medical aid membership); Children under the age of 26: Children need to be on the medical aid membership of the Principal Insured person or spouse; Full-time students who are on their own medical aid membership (proof of studies and medical aid membership certificate); Children over 26 years who are physically or mentally disabled and unable to earn any form of income. Turnberry brochure 2027, p20
- If you have an Adult Dependant (sibling, parent etc.) on your Medical Aid membership who isn’t covered under the family premium you may add them on to your policy, but you will need to pay an additional premium per month for each Adult Dependant. Turnberry brochure 2027, p20
What each benefit means
In Turnberry’s own words, with its examples of when it pays and when it doesn’t.
Co-payment Cover
With Turnberry’s Co-Payment Cover (available on selected plans), you can claim back these out-of-pocket expenses, ensuring you’re not left financially exposed when undergoing approved procedures.
Turnberry brochure 2027, p6
Non-DSP Hospital Cover
For example, if your medical scheme requires you to use Hospital X but you opt for Hospital Y instead, you may need to pay a set amount upfront. With Turnberry’s Gap Cover (available on selected plans), this cost can be claimed back, helping you access care where it suits you best.
Turnberry brochure 2027, p6
Medical Expense Shortfall Cover
Turnberry’s Gap Cover helps bridge this gap, giving you financial protection when your medical scheme funding falls short.
Turnberry brochure 2027, p6
Medical Expense Shortfall Cover – includes
Medical Expense Shortfall Cover includes cover for: Specialists, Basic and specialised Radiology, Physiotherapy, Consumables (e.g. plasters, cotton wool etc), Pathology, Prescribed Minimum Benefits
Turnberry brochure 2027, p6
Sub-limit Cover – Pathology
Turnberry’s sub-limit cover also includes cover for pathology if your medical scheme has an annual limit for pathology.
Turnberry brochure 2027, p6
Sub-limit Cover – Robotic Surgery
Most medical schemes fund for robotic surgery up to a global fee, where all the treatment is capped at a rand value. Sub-limit cover, assists in these instances
Turnberry brochure 2027, p6
Sub-limit Cover – Internal Prosthesis
Includes but not limited to: prosthetic hips, intraocular lenses, stents, cochlear implants, heart valves, screws, rods, cages used in surgery, hernia mesh, pacemakers
Turnberry brochure 2027, p6
Traditional Cancer Cover
If you have depleted your cancer benefit on your Medical Scheme, you may become liable for co-payments or the full cost of any further cancer treatment, as specified by your Medical Scheme.
Turnberry brochure 2027, p7
Biological Cancer Drugs
The lists below provide the Biological Cancer Drugs covered under Premier, Optimal and Dynamic
Turnberry brochure 2027, p19
Waiting periods
In Turnberry’s own words.
- A 3-month general waiting period applies to all benefits (except in the event of an accident, which occurred while on the Policy). In the event the commencement date of the Policy is the same as the commencement date of the Medical Scheme, no 3-month general waiting period will apply to Medical Expense Shortfall Cover. Turnberry brochure 2027, p19
- A 10-month waiting period on pregnancy/childbirth. Turnberry brochure 2027, p19
- A 12-month waiting period on investigations, treatment or surgery for: hysterectomy, hysteroscopies, endometriosis, ovarian cysts and fibroids (myomectomy), muscular-skeletal (except in the event of an accident, which occurred while on the Policy), tonsillectomy, myringotomy, grommets, adenoids, wisdom teeth, hernia, cataracts, gastroscopies, colonoscopies, cancer, nasal and sinus. Turnberry brochure 2027, p19
Before you join
Printed on Turnberry’s forms.
- I confirm I have fully discharged my duties as set out in section 8(d) of the General Code of Conduct Turnberry application form 2027, p3
How to claim
In Turnberry’s own words.
Claiming
You can get the claim form under documents on our website. You can also access the online claim form at https://turnberry.co.za/claim-form/ (this can be completed and submitted online).
Turnberry brochure 2027, p22
Claiming
Once a claim is admitted, the claimed amount is paid directly to the Policyholder who must settle outstanding amounts with the service providers. Provided that all requirements are received valid claims are settled within 10 working days.
Turnberry brochure 2027, p22
Claiming
You have 5 months to provide written notice from the date of treatment of a pending claim. Outstanding documentation needs to be submitted within 90 days from the date, outstanding documentation is requested by Turnberry.
Turnberry brochure 2027, p22
What each document is for
| Document | Where to get it | Why Turnberry needs it | Note |
|---|---|---|---|
| Invoices | |||
| Hospital accounts | |||
| Medical Aid Remittance / Claim Statement |
Turnberry brochure 2027, p22
Claim examples
In Turnberry’s own words.
- Mark reached his Medical Scheme’s R250 000 cancer benefit limit while still requiring further chemotherapy. Although his Medical Scheme continued to cover 80% of the treatment costs, Mark remained responsible for the remaining 20%. Fortunately, his Financial Advisor had recommended a Turnberry Optimal Gap Cover policy. This allowed Mark to claim the eligible shortfall from Turnberry, helping him continue his treatment with greater financial confidence and peace of mind. Turnberry brochure 2027, p7
What it does not pay for
Turnberry’s exclusions (24)
- Nuclear weapons or nuclear material or by ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception combustion shall include any self-sustaining process of nuclear fission;
- LASIK or Lasik (laser-assisted in situkeratomileusis) surgery or any type of refractive surgery for correcting myopia, hyperopia, and astigmatism;
- Investigations, treatment or surgery for obesity its sequela or cosmetic surgery or surgery directly or indirectly caused by or related to or in consequence of cosmetic surgery other than as a result of an insured event otherwise insured. For the purpose of this exception cosmetic surgery shall include surgery for breast reduction or reconstruction unless necessitated as a result of treatment for cancer;
- Routine physical or any procedure of a purely diagnostic nature or any other examination where there are no objective indications of impairment in normal health and laboratory diagnostic or X-ray examinations except in the course of a disability established by prior call or attendance of a Medical practitioner;
- Suicide, attempted suicide or intentional self-injury;
- The taking of any drug or narcotic unless prescribed by and taken in accordance with the instructions of a Medical Practitioner (other than the Insured person) or drug addiction;
- An event directly attributable to the Insured person having an alcohol content exceeding the legal limit or the Insured person suffering from alcoholism or any illness caused by the use of alcohol;
- Participation in: a. Active military duty, police duty, police reservist duty, civil commotion, labour disturbances, riot, strike, or the activities of locked-out workers b. Aviation other than as a passenger c. Any form of race or speed test (other than on foot or involving any non-mechanically propelled vehicle, vessel, craft or aircraft);
- Investigations, treatment or surgery for artificial insemination or hormone treatment for infertility;
- No benefits are payable which should be provided by the Medical Scheme, this exception includes ward fees, theatre fees, medicines, appliances and other hospital expenses;
- No benefits shall be payable in the event of fraudulent submission by the claimant;
- No benefits shall be payable in the event the insured did not pre-authorise, make use of a Designated Service Provider (this is not applicable to the Non-DSP Hospital Penalty Cover on Premier, Optimal and Synergy) or any condition set by the Insured’s Medical Scheme;
- No benefits shall be payable in the event there is no benefit for the treatment and/or the condition or if it is excluded and/or declined by the Insured’s Medical Scheme (including split billing) or if the Medical Scheme pays less than tariff for benefits associated with costs incurred above Medical Aid rate;
- No benefit shall be payable in respect of any medical or surgical treatment unless such treatment occurred during the period of hospital confinement as an in-patient or as an out-patient (as defined);
- The table of benefits applies in the territory of the RSA and no benefits are payable for expenses incurred for transport charges or for services rendered whilst being transported in any emergency vehicle, vessel or aircraft;
- No ward fee benefits shall be payable in respect of any additional costs incurred as a result of confinement to a private ward if such confinement to a private ward was requested by the Insured person;
- Treatment resulting from failure to carry out the instructions of a Medical Practitioner;
- Treatment for the Casualty Illness Benefit when treatment was not received between the hours of 18:00-06:00 Mondays-Fridays, Saturdays, Sundays and Public Holidays;
- Injuries arising from professional sport or any other recreational activity which is not commonly recognised as a sport and/or involves uncontrolled competition, unusual skill or violent activity and is generally considered to be inherently dangerous for the emergency casualty benefit (as defined in the Policy document) provided in a hospital out-patient emergency facility;
- Psychiatric conditions including but not limited to depression, insanity, mental and or stress related conditions for co-payments and sub-limits;
- Co-payments and Sub-limits are covered for dentistry except for investigations, treatment or surgery related to dental implants, except in the event for reconstructive maxillofacial surgery as a result of oral cancer or an accident (which occurred/ was diagnosed while on the Policy) and will be limited to R50 000 per policy per annum. No benefit is payable while an Insured person is within a waiting period;
- Benefit 1 (Private Rate Cover) for dentistry is limited to impacted wisdom teeth, orthognathic surgery, and/or reconstructive maxillofacial surgery as a result of an accident while on the Policy and oral cancer (which was diagnosed while on the Policy). No benefit is payable while an Insured person is within a waiting period;
- Basic Dental Medical Expense Shortfall Cover for children will only be covered for children up to (and including) 12 years of age.
- No benefits shall be payable for gender reassignment treatment and/or surgery or the reversal thereof.
Turnberry brochure 2027, p21
Words used
As Turnberry defines them.
- Gap Cover
- Gap Cover is short-term insurance designed to help protect you against certain medical expense shortfalls not fully covered by your medical scheme. These may include co-payments, sub-limits and specialist fees charged above the scheme rate. As healthcare costs continue to rise and medical scheme benefits become more restricted, Gap Cover provides an important layer of financial protection. It helps reduce the impact of unexpected medical expenses, giving you greater confidence and peace of mind when you need it most. Turnberry brochure 2027, p4
- Co-payment / deductible
- Certain medical procedures or scans require an upfront payment—known as a co-payment or deductible—before treatment can take place. These costs are determined by your medical scheme and can apply at hospitals, radiologists, or day clinics. Turnberry brochure 2027, p6
- Medical expense shortfall
- A medical expense shortfall occurs when the amount charged by healthcare providers—such as doctors, specialists, radiologists, or pathologists—exceeds what your medical scheme covers from its hospital or risk benefit. These shortfalls often arise during treatment in hospitals or day clinics and can result in significant out-of-pocket costs. Turnberry brochure 2027, p6
- Sub-limit
- When a Medical Scheme will only pay for a certain procedure, prosthetic device or scan up to a specified limit, this is a sub-limit. Turnberry brochure 2027, p6
- Designated Service Provider (DSP) / Non-DSP
- If you choose to receive treatment at a hospital or day clinic that is not part of your Medical Scheme’s Designated Service Provider (DSP) network, you may be responsible for a portion of the bill, as defined by your scheme. Turnberry brochure 2027, p6
- Overall Annual Limit (OAL) / Demarcation Regulations
- National Treasury annually publishes new limits under the Demarcation Regulations. The changes are effective from 1st April. Please refer to our website for the latest Overall Annual Limit (OAL) on each of our products. Turnberry brochure 2027, p26
Questions about Optimal
Answered from Turnberry’s brochures.
How much does Optimal cost in 2027?
From 1 January 2027: R600 a month at 0 to 64; R870 a month at 65 and older. One premium covers the whole family.
How much is Optimal going up for 2027?
For a family at 0 to 64, from R558 to R600 a month, +7.5%.
Is there a waiting period?
Yes. 3 months general, and 12 months for conditions you had before joining.
Does Optimal cover cancer?
Yes, Optimal includes cancer cover.
Which co-payments does it cover?
One co-payment a year that your medical scheme charges.
Factual information from Turnberry’s published brochures. It is not advice. Compiled by Eldon de Waal, CFA, the licensed advisor behind AURA. Catalogue v175, built 2026-10-19.