If you've tried to claim medical expenses on your ITR12, you've probably hit the same wall. SARS doesn't want a story. It wants proof. Remembering that you spent a lot on physio this year counts for nothing without the paperwork behind it.
The good news: the paperwork isn't complicated, just scattered. A tax year of medical spending usually lives across a medical scheme portal, a stack of till slips in a drawer, and twelve months of bank statements. Once you know which documents map to which SARS code, gathering them becomes a checklist, not a mystery.
This post is that checklist.
Why do the documents matter more than the numbers?
SARS doesn't calculate your medical tax credit from a number you type in. It works off the evidence behind that number: what your medical scheme already reported, and what you can prove you paid yourself and never recovered.
It comes down to this: match each rand you spent to a document that proves three things, that it was a genuine medical expense, that you paid it, and that you weren't reimbursed for it. Miss the paper trail and a legitimate expense can't be claimed. It's also why the Additional Medical Expenses Tax Credit (AMTC), the part of the credit built from your own receipts rather than your scheme contributions, is the piece most South Africans under-claim. For the full mechanics of how that credit is calculated, see SARS codes 4005, 4020 and 4034: what's the difference?.
The complete document checklist
Gather all of this once, before you or your tax practitioner touches the ITR12.
1. Your medical scheme tax certificate (ITS3(a))
This is the certificate your medical scheme issues after the tax year ends, usually available for download from their member portal from around May/June. It shows:
- Total contributions paid for the year (this becomes SARS code 4005)
- Any qualifying medical expenses the scheme itself already flagged as "not recovered from the scheme" (this becomes code 4020)
Get this for every medical scheme you or your dependants belonged to during the year, even if you switched schemes partway through.
2. The scheme's claims extract
Separate from the certificate, most schemes let you download a full claims history: every claim submitted, what was paid, and what was rejected or only partially covered. This document is what lets you, or the AI doing the reconciliation, tell the difference between claims the scheme already told SARS about and expenses that never touched the scheme at all.
3. Every invoice or receipt for anything not on the certificate
This is the bulk of the work, and the part people usually under-claim. Any qualifying medical expense you paid out of pocket that doesn't appear on the certificate needs its own invoice or till slip: GP and specialist visits, dentist and optometrist fees, prescribed medicine, hospital and theatre fees, home nursing, and disability-related equipment. Over-the-counter items and unprescribed supplements generally don't qualify, so keep those separate.
4. Bank and credit-card statements covering the full tax year
Every statement from 1 March to 28/29 February, for every account you might have paid a medical expense from. These aren't optional extras. They prove you paid the amount on the invoice, and they often catch expenses you'd otherwise forget (a card-machine payment at a physio six months ago rarely makes it into anyone's memory, let alone a spreadsheet).
5. Proof of relationship, if you're claiming for a spouse or dependant
If you're including a spouse or dependant's medical expenses in your own claim, keep proof of the relationship on hand: a marriage certificate, or proof of financial dependency for a child or other dependant. SARS can and does ask for this if a claim is queried.
6. The ITR-DD, if disability applies
If you, your spouse, or a dependant has a disability as defined by SARS, a completed ITR-DD form (confirmed by a registered medical practitioner) changes the AMTC sum in your favour. There is no income threshold at all. The same is true once you or your spouse turns 65. Both situations deserve their own look at your documents. See Turning 65: what happens to your medical tax credit and What is the disability medical tax credit? for how the numbers shift.
Which document proves code 4020, and which proves 4034?
This distinction trips people up, so it's worth stating plainly:
- Code 4020 covers qualifying expenses your medical scheme has already flagged as unpaid or not recovered, proven by the ITS3(a) certificate. The scheme did the detective work for you.
- Code 4034 covers qualifying expenses that never appear on any scheme certificate, proven only by your own invoices, till slips and matching bank payments. Nobody hands you this number. You reconstruct it yourself from a year of paperwork.
Code 4034 is almost always the biggest source of under-claimed credit, because it needs the reconciliation work in point 3 above rather than a single downloaded PDF. For a deeper look at what typically hides in that pile, see SARS code 4034: what it lets you claim back.
A worked example
Say a 42-year-old taxpayer, no disability, has a taxable income of R450,000 for the year and paid R48,000 in medical scheme contributions covering themselves and one dependant.
Annual MTC (2026 tax year) = (R364 + R364) × 12 = R8,736.
Under the under-65, no-disability formula:
AMTC = 25% × [ (R48,000 − 4 × R8,736) + other out-of-pocket expenses − 7.5% × R450,000 ] AMTC = 25% × [ (R48,000 − R34,944) + other expenses − R33,750 ] AMTC = 25% × [ R13,056 + other expenses − R33,750 ]
If "other qualifying expenses" (the receipts never claimed from the scheme) total R15,000, the bracket is R13,056 + R15,000 − R33,750 = −R5,694, which floors to zero. No AMTC at all, because the 7.5%-of-income threshold hasn't been cleared.
But if that receipt pile is R40,000 (common once bank statements are reconciled against invoices), the bracket becomes R13,056 + R40,000 − R33,750 = R19,306, and the AMTC is 25% × R19,306 = R4,826.50. Same taxpayer, same income. The only thing that changed is how completely the receipts were gathered.
That gap between R0 and R4,826.50 is the kind of money that sits undiscovered in a shoebox. It's worth naming a real example of what a fully reconciled document set can surface: in one real, SARS-verified SecureSlip case, 155 source documents were reconciled into a verified claim of R177,459.64 in additional out-of-pocket expenses across 68 line items, all of it money that had never appeared on any medical scheme certificate. One case, and everyone's year is different, so treat it as an example, not a promise. If under-claiming sounds familiar, our post on why most people miss the threshold covers why this happens so often.
From checklist to submission-ready pack
Gathering this list yourself is a spreadsheet project: matching a year of till slips to a year of bank statements, line by line, while making sure nothing double-counts against the scheme certificate. It's the kind of tedious, error-prone reconciliation that's easy to get wrong under time pressure near a filing deadline.
This is what SecureSlip automates. You send the documents above: invoices, certificates, claims extracts, statements, and relationship proof if relevant. Private, on-device AI classifies each document and extracts the figures, then matches every expense to its bank payment and reconciles it against the scheme's own certificate to isolate what's new (code 4034) from what's already covered (code 4020). Every AI-read figure is cross-checked by deterministic arithmetic rather than trusted outright, and anything uncertain goes to a human reviewer before it's finalised. You then receive a numbered, submission-ready schedule and cover letter, ready for you or your tax practitioner to review and file. SecureSlip prepares the evidence. It doesn't give tax advice, and it doesn't lodge the return on your behalf.
Your checklist, in order
- Download the medical scheme tax certificate (ITS3(a)) for every scheme you belonged to.
- Download the full claims extract from each scheme.
- Gather every invoice/receipt for medical expenses not shown on the certificate.
- Pull bank and credit-card statements for the full tax year, all relevant accounts.
- Collect proof of relationship for any spouse or dependant included in the claim.
- If applicable, get the ITR-DD completed by a registered medical practitioner.
- Reconcile everything against the certificate to separate code 4020 from code 4034, or let a service like SecureSlip do that reconciliation for you.
This article is general information. It isn't tax advice. SARS reviews the monetary rebate and credit amounts annually, so confirm the current tax year's figures, and your own eligibility, with SARS or a registered tax practitioner before filing.
If gathering and reconciling a year of receipts sounds like too much admin, try the free estimator at /calculator to get a sense of what your own documents might be worth, read /how-it-works to see the full process before you send anything, or get in touch if you'd like help turning your document pile into a submission-ready pack.