Official SARS Tax Guide • Updated for 2026 / 2027 Tax Year

Complete Guide to Medical Tax Credits in South Africa (Section 6A & 6B)

Learn how to calculate your Section 6A fixed rebate, navigate the Section 6B 7.5% income floor, claim out-of-pocket medical expenses, and maximize your SARS refund on eFiling.

Compiled by SA Accounting Network • Income Tax Act No. 58 of 1962

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Quick Summary: How SARS Medical Tax Credits Work

South Africa utilizes a tax credit system (rebates) rather than direct income tax deductions for medical relief. This ensures equal Rand-for-Rand tax relief for all income earners:

  • Section 6A Credit: A fixed monthly tax rebate for belonging to a registered medical scheme (R376/mo for the first two members, R254/mo for additional dependants). It directly reduces your monthly PAYE tax liability.
  • Section 6B Credit (Under 65): An annual credit equal to 25% of qualifying expenses that exceed your 7.5% taxable income floor.
  • Section 6B Credit (Ages 65+ or Disability): An annual credit equal to 33.3% of qualifying expenses with zero income floor (starts from Rand 1 of spend).

1. The Evolution of Medical Tax Relief in South Africa

Prior to the implementation of the medical tax credit system between 2012 and 2015, medical expenses were treated as a deduction against taxable income. Under the old deduction regime, higher-income earners in top tax brackets received significantly greater tax benefits than lower-income earners.

SARS replaced deductions with standard tax credits. Tax credits reduce your calculated tax bill directly Rand-for-Rand, ensuring equal relief across all income brackets.

Feature Old System (Pre-2012) Current System (Section 6A & 6B)
Mechanism Reduced gross taxable income Directly reduces calculated tax payable (Rebate)
Equity Favored high-income earners Standardized rebates for all taxpayers
Timing Claimed strictly on annual return Sec 6A claimed monthly via PAYE; Sec 6B claimed on annual return

2. Section 6A: Medical Scheme Fees Tax Credit

Section 6A provides a fixed monthly rebate to taxpayers who pay contributions to a registered South African medical scheme for themselves or their dependants. This rebate is applied directly against your monthly PAYE tax liability on your payslip.

Section 6A Rebate Rates (2026/2027 Tax Year)

Main Member / 1st Dependant
R376 / month
(R4,512 per year)
Each Additional Dependant
R254 / month
(R3,048 per year)

Key Section 6A Rules:

  • No Income Requirement: Granted regardless of your taxable income level, provided tax is payable.
  • Non-Refundable: Section 6A credits can reduce your PAYE tax to R0, but cannot trigger a negative tax bill or cash payout from SARS.
  • Registered Schemes Only: Applies strictly to medical schemes registered under the Medical Schemes Act.

3. Section 6B: Additional Medical Expenses Tax Credit & The 7.5% Floor

Section 6B provides additional tax relief for out-of-pocket medical expenses and excess scheme contributions paid during the tax year. Unlike Section 6A, Section 6B is claimed annually on your ITR12 tax return.

Understanding the 7.5% Taxable Income Floor

For taxpayers under age 65 without a recognized disability, SARS imposes an "income floor". You only receive tax relief on qualifying medical spend that exceeds 7.5% of your total annual taxable income.

The Section 6B Formula (Under 65):

  1. Calculate Excess Scheme Contributions: Total Scheme Fees Paid – (4 × Annual Section 6A Credit).
  2. Calculate Total Qualifying Spend: Excess Scheme Contributions + Unreimbursed Out-of-Pocket Bills.
  3. Calculate Income Floor: 7.5% × Total Annual Taxable Income.
  4. Determine Spend Above Floor: Total Qualifying Spend – Income Floor.
  5. Apply Credit Rate: Spend Above Floor × 25% = Section 6B Tax Refund.

4. What Medical Expenses Qualify for Section 6B?

Qualifying Expenses

  • Unreimbursed Out-of-Pocket Bills: Doctor fees, specialist consultations, hospital charges, and nursing care paid out of pocket.
  • Prescribed Medicines: Prescription medication obtained from a registered pharmacy.
  • Excess Scheme Fees: Medical aid contributions exceeding 4× your Section 6A credit (or 3× for 65+/disability).
  • Registered Practitioners: Services rendered by practitioners registered with the HPCSA or relevant statutory body.

Non-Qualifying Expenses

  • Over-the-Counter (OTC) Medicines: Non-prescribed pain relievers, vitamins, or supplements bought off the shelf.
  • Gap Cover & Hospital Cash Plans: Monthly premiums for Gap Cover or short-term health policies (not registered medical schemes).
  • Reimbursed Costs: Any expense paid out or refunded by your medical aid or insurance policy.
  • Elective Cosmetic Surgery: Aesthetic procedures not deemed medically necessary by a practitioner.
  • Travel & Transport: Fuel, parking, or travel costs to visit a doctor or hospital.

5. Special Rules: Taxpayers Aged 65+ & Disability Relief

Taxpayers aged 65 or older, or households supporting a person with a qualifying disability, receive enhanced tax relief under Section 6B.

Income Floor
R0 Floor
(No threshold restriction)
Credit Percentage
33.3% Credit
(Increased from 25%)
Scheme Multiplier
3× Multiplier
(Lower benchmark threshold)

Non-Obvious Conditions That Qualify for SARS Disability Relief

Qualification for disability relief depends on functional limitation (moderate-to-severe restriction on daily activities lasting over 1 year), verified via a signed ITR-DD form:

  • Neurodevelopmental Conditions: Severe ADHD/ADD, Autism Spectrum Disorder (ASD), Dyslexia, or Dyscalculia requiring remedial therapy or specialized schooling.
  • Mental Health Conditions: Severe Bipolar Disorder, Major Depressive Disorder, PTSD, or Anxiety causing functional impairment.
  • Sensory Impairments: Visual impairment (vision less than 6/18 in better eye) or severe hearing loss.

6. Master Case Study: Comparing Scenarios

Below is a side-by-side comparison of Jannie (earning R25,000/month or R300,000/year) across different medical cover levels, expenses, and age tiers:

Scenario Med Aid Cost / Year Out-of-Pocket Bills Qualifying Spend Above Floor Final Sec 6B Credit / Refund
1A: No Med Aid + Low Bills R0 R10,000 -R12,500 (Under Floor) R0
1B: No Med Aid + High Bills R0 R50,000 R27,500 R6,875
2A: R2k/mo Med Aid + R0 Bills R24,000 R0 -R16,548 (Under Floor) R0 (Only Sec 6A R4,512)
2B: R5k/mo Med Aid + R0 Bills R60,000 R0 R19,452 R4,863
2C: R5k/mo Med Aid + R10k Bills R60,000 R10,000 R29,452 R7,363
3: Age 70 + R5k Med Aid + R10k Bills R60,000 R10,000 R56,464 (No Floor!) R18,802

7. SARS Audit Proofing & Record-Keeping Checklist

SARS heavily audits Section 6B claims. Follow these record-keeping best practices to ensure your tax refund is paid out without delays:

1. Proof of Payment is Mandatory

Retain original tax invoices AND bank statements/card receipts proving you personally settled the bill. An unpaid invoice will be rejected by SARS auditors.

2. Submit All Bills to Medical Aid

Submit every medical invoice to your scheme—even if unpaid—so it is reflected on your official annual tax certificate (Code 4005/4025).

3. Prevent "Double Dipping"

SARS cross-checks claims against medical aid records. Never claim expenses that were reimbursed by your medical aid scheme or Gap Cover.

4. Valid ITR-DD Disability Form

If claiming under disability rules, ensure your medical practitioner completes Part A & B of the ITR-DD form prior to filing your return.

Frequently Asked Questions

Yes, you can claim qualifying out-of-pocket medical expenses under Section 6B on your annual return even if you don't belong to a medical aid. However, because you are not a scheme member, your Section 6A monthly credit is R0. For taxpayers under 65 without a disability, these expenses are still subject to the 7.5% taxable income floor—meaning you only receive a 25% tax credit on qualifying expenses that exceed 7.5% of your annual taxable income.

Hospital plan contributions qualify for Section 6A and 6B credits only if the plan is offered by a registered medical scheme under the Medical Schemes Act. On the other hand, premiums for Gap Cover, medical insurance, and hospital cash plans do not qualify. These are short-term insurance products, and SARS strictly excludes non-registered insurance premiums from tax relief.

Section 6A is a fixed monthly rebate granted simply for belonging to a registered medical aid scheme, applied against your monthly PAYE tax on your payslip. Section 6B is an additional annual credit claimed on your tax return for qualifying out-of-pocket medical expenses and excess scheme contributions above statutory income thresholds.

Turning 65 completely removes the 7.5% taxable income floor, increases your rebate rate from 25% to 33.3%, and lowers the scheme excess multiplier from 4× to 3×. This significantly increases your end-of-year Section 6B refund on assessment.

Over-the-counter medicines (like non-prescribed pain relievers, cough syrups, or vitamins) bought off the shelf do not qualify. Only medicines prescribed by a registered healthcare practitioner and dispensed by a registered pharmacy qualify under Section 6B.

To claim enhanced Section 6B credits under disability rules (33.3% credit with R0 floor), you must have a valid ITR-DD form (Confirmation of Diagnosis of Disability) completed and signed by a registered medical practitioner. The form must be retained for audit verification and renewed every 1 to 10 years depending on the diagnosis.

Interactive Medical Tax Credit Calculator

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Do you want to claim medical tax credits or additional medical expenses on your return? Complete the form then one of our tax experts will get in touch!