It depends on the patient's plan. Some South African medical schemes cover one pair of glasses, or contact lenses of similar value, once every 24 months. Others give each person an annual optometry limit that resets every year. Patients often do not know which they have, so the practice that explains it clearly, and contacts patients when their benefit is due, gets the booking.
For optometry practices, the benefit cycle is both the most common source of confusion at the counter and the most predictable source of returning patients.
This is a general guide based on published scheme documents. Benefits differ by scheme, plan and year, so always work from the patient's current benefit.
Why the benefit matters so much in optometry
Medical schemes fund a small, specific slice of eye care. A study of Council for Medical Schemes data found that eye care made up 3.1% of total benefits paid in 2020, that optometry was funded largely from personal medical savings accounts, and that members paid 18% of optometry costs out of pocket (Willie, African Vision and Eye Health, 2023). The same paper notes that schemes "typically only cover fundamental vision requirements, such as eye exams, lenses and a basic frame".
For many patients, the scheme benefit decides when they come in. That makes knowing the cycle part of your front desk's job.
The two common benefit types
| 24-month benefit | Annual optometry limit | |
|---|---|---|
| How it works | One pair of glasses (or contact lenses of similar value) per person every 24 months | A rand limit per person per year for lenses, frames, contact lenses and related services |
| When it renews | Usually 24 months from the last claim | Usually the start of the benefit year |
| Typical rules | May be limited to a network and a set range of frames | May be pro-rated if the member joined mid-year |
| Lost or broken glasses | Often not replaced before the cycle ends | Can be claimed if the limit has money left |
Two examples from 2026 scheme guides show both models:
- 24-month. TFG Medical Aid Scheme's TFG Health option covers one eye test and one set of lenses at a network optometrist, and "one pair of new glasses or contact lenses to the approximate value of new glasses, every 24 months". It adds that glasses "will not be replaced before the Benefit period expires, even if they are lost, stolen, broken" (TFG Medical Aid Scheme, 2026).
- Annual. Discovery's 2026 optometry guide gives an annual limit per person on its Executive, Comprehensive and Priority plans, for example R10,950 on Executive and R7,500 on the Comprehensive series. It says the limit is adjusted if a member joins during the year, and that eye tests are not subject to the limit (Discovery Health Medical Scheme, 2026).
What patients most often get wrong
- "It renews in January." On a rolling 24-month benefit, the date runs from the last claim. Bankmed explained its own rolling cycle this way: "if you claimed for spectacles in April 2019, the next time you can claim for spectacles is April 2021" (Bankmed).
- "My scheme will replace them, I broke them." Within a 24-month cycle, often not.
- "It's all covered." Benefits may be limited to a frame range, a network or a rand amount, and lens enhancements may not be included. TFG's guide, for example, excludes tints, hard coating and sunglasses on its network option.
- "My whole family renews together." Each person's cycle can differ.
A short, written explanation at dispensing, showing the patient's next eligible date, prevents most of these.
Build recall around the renewal date
Record two dates for every patient: the clinical recall date the optometrist recommends for their next eye examination, and the date their spectacle benefit is next available. Then:
| When | Action |
|---|---|
| At dispensing | Note both dates on file and tell the patient |
| 4 to 6 weeks before the benefit date | Message: "Your optical benefit may be available again from [date]. Would you like to book an eye test?" |
| At the clinical recall date | Recall message based on the optometrist's recommendation |
| Before a booked appointment | Reminders with an easy way to move it |
| No response after two attempts | Record it and stop |
Word it carefully. Say the benefit "may be available" and ask the patient to confirm with their scheme, rather than promising cover you cannot guarantee.
Keep recall messages about the patient's own eye care. Adding frame promotions turns a reminder into direct marketing, which has separate consent rules. Our guide to WhatsApping patients under POPIA explains the difference.
Make it easy to book when they are ready
Patients often act on a benefit reminder in the evening or at the weekend. If they cannot get through, the booking may go to whichever practice answers first. Remi answers your line at any hour, books eye tests straight into your diary and sends reminders at 48 hours, 24 hours and 2 hours before each appointment. It does not check benefits or give clinical advice: questions about a patient's scheme or their eyes go to your team, with a clear message.
For the wider picture, our page on an AI receptionist for optometrists explains how bookings and urgent calls are handled, including patients ringing about a sudden problem with their sight, which Remi puts through to the person you choose.
The short version
- Optical benefits come in two main forms: one pair every 24 months, or an annual rand limit.
- A 24-month cycle usually runs from the last claim, not from January, and lost glasses are often not replaced within it.
- Annual limits may be pro-rated for new members, and eye tests may sit outside the limit.
- Record each patient's benefit date and clinical recall date separately.
- Remind patients before the benefit date, say it "may be available", and let them book in one step.