Does medical aid cover eye tests and glasses in South Africa?
By See Better · Updated · 5 min read
The short answer
Most South African medical aid plans with an optical benefit pay for one eye test per person per benefit cycle, plus a set amount towards a frame and standard lenses or contact lenses. The cycle is often 24 months. Hospital plans usually have no optical cover. The exact limits depend on your scheme and plan.
Key points
- Optical benefits normally renew on a cycle, often every 24 months.
- A typical benefit covers an eye test, a frame up to a limit, and standard clear lenses.
- Coatings, tints and upgraded lenses are often paid from your own pocket.
- See Better is registered with most medical aids and charges at medical aid tariffs.
What an optical benefit usually covers
Every scheme writes its own rules, but optical benefits tend to follow the same pattern. For each person on the plan, once per benefit cycle, a typical benefit pays for:
- one eye test, usually in full at the scheme's rate
- a frame, up to a rand limit
- a pair of lenses: standard clear single vision, bifocal or multifocal lenses, according to your prescription
- or contact lenses instead of glasses, up to a rand limit
You normally choose glasses or contact lenses in a cycle, not both.
The benefit cycle
On many plans the optical benefit is available once every 24 months. Some plans work on a 12-month cycle. Schemes also count the cycle differently. Many count from the date you last claimed, so if you claimed for glasses in March 2025 on a 24-month plan, your next benefit opens in March 2027. Others use fixed two-year periods that are the same for every member.
Because the date can differ for each member of the family, it is worth asking your scheme for everyone's next available date. Benefits you do not use generally do not carry over.
What is usually not covered
Expect to pay for some or all of these yourself:
- the part of a frame price above your plan's frame limit
- lens extras such as anti-reflective coatings, photochromic lenses, tints and thinner lens materials
- premium multifocal designs, where the scheme pays for a standard design only
- a second pair of glasses or prescription sunglasses in the same cycle
- an extra eye test before your cycle renews
These shortfalls are called co-payments. A good optometrist will tell you the amount before you order, so there are no surprises.
Which plans have optical cover?
- Comprehensive and many mid-range plans usually include a defined optical benefit.
- Savings plans often pay optical claims from your medical savings account, so the money is yours but limited to what is in the account.
- Hospital plans generally do not cover eye tests or glasses at all.
- Network plans may require you to use an optometrist on the scheme's optical network to get the full benefit.
Many schemes hand the management of optical benefits to a specialised network company, so you may see a name such as PPN, Iso Leso or Opticlear on your benefit guide alongside your scheme's name.
Questions to ask your scheme
Phone the number on your card, or check the app, and ask:
- Do I have an optical benefit, and when does it next become available for each person on my plan?
- Is the eye test covered in full?
- What is my frame limit?
- Which lens types are covered, and are multifocals included?
- Must I use an optometrist on a particular network?
- Is the benefit paid from my savings or from the scheme's risk benefit?
Using medical aid with See Better
See Better is registered with most medical aids and charges at medical aid tariffs. When you book, send us the name of your scheme and plan on WhatsApp so that we can tell you how your benefit works before we visit. The eye test happens at your home or workplace, exactly as it does for cash clients.
If you do not have optical cover
You can pay cash. See Better's cash prices are fixed and published: R450 for an eye test at home, and from R1199 for a test with a frame and tinted single vision lenses. For a wider view of what tests cost, see what an eye test costs in South Africa.
Whether you pay with medical aid or cash, do not skip the test to save money. How often you should have an eye test explains why a check every two years matters even when your sight seems fine.
Frequently asked questions
How often does medical aid pay for new glasses?
On most plans with an optical benefit, once every 24 months per person. Some plans allow a claim every 12 months. The cycle often runs from the date of your last claim, so ask your scheme for your next available date.
Does a hospital plan cover eye tests?
Generally not. Hospital plans cover treatment in hospital and usually exclude day-to-day benefits such as eye tests and glasses. You would pay the cash price.
Does medical aid pay for multifocal lenses?
Many plans do, but often only for a standard multifocal design. If you choose a more advanced design or add coatings, you pay the difference.
Can I claim for an eye test even if I do not need glasses?
Yes. The eye test is a benefit on its own. If the test shows you do not need glasses, you have still had your eye health checked, and your frame and lens benefit remains available for the rest of the cycle.
This article is general information and is not a diagnosis or a substitute for an eye examination. If you are worried about your eyes or your sight, see an optometrist or a doctor. Sudden loss of vision, eye injuries and severe eye pain are emergencies.
