In one real case from SecureSlip's own files, a year of medical documents reconciled into a verified claim of R177,459.64 in extra out-of-pocket medical expenses. That's 155 documents: till slips, specialist invoices, bank and credit-card statements, and two medical scheme tax certificates, across 68 individual line items. Every rand was money the taxpayer had spent and never recovered from their medical scheme. None of it appeared on the scheme's own certificate. Left unreconciled, it would have gone unclaimed.
That's one real case, not a promise of what you'll find. Everyone's documents, spending and circumstances differ. But it shows what a single SARS code is designed to capture, and why it so often goes unclaimed. That code is 4034, and it's worth fifteen minutes to understand.
What are the three codes on your medical scheme certificate?
Every year your medical scheme sends a tax certificate, the ITS3(a), showing what you paid it and what it says you didn't recover. Three SARS codes come out of that certificate:
- Code 4005: total medical scheme contributions you paid for the year.
- Code 4020: qualifying medical expenses the scheme itself already flagged as "not recovered" on its certificate.
- Code 4034: extra qualifying medical expenses you paid out of pocket that don't appear on any medical scheme certificate.
The first two numbers arrive on one document. Your scheme hands you 4005 and 4020 together, already worked out, on the ITS3(a). Code 4034 is different. Nobody hands it to you. You have to assemble it yourself, receipt by receipt, from a year of GP visits, dental work, physiotherapy, prescribed medicine bought at a retail pharmacy, specialist co-payments, and anything else you paid for directly and never claimed back. For the fuller picture of how these three codes relate and feed into your ITR12, read SARS codes 4005, 4020 and 4034: what's the difference?.
Why does code 4034 get missed so often?
There's a simple reason 4034 gets missed more often than the other two. Codes 4005 and 4020 are worked out for you. Your scheme has already done the reconciliation and printed the number. Code 4034 asks you to do that work yourself, across every document from the whole year, with no single source that lists it.
In practice that means matching a till slip from a pharmacy to the bank statement line it came off. It means checking the item wasn't also submitted to the scheme, and confirming it's a qualifying medical expense, not an over-the-counter or cosmetic item. Then doing that for every receipt in the pile, not just the big hospital bill, but the R180 dispensing fee and the R650 physio session too. It's slow, unglamorous reconciliation work, and it's easy to put off until it's forgotten. We've written more about why this happens so often in our post on why most people miss the threshold.
It matters for another reason too: how the Additional Medical Expenses Tax Credit (AMTC) gets calculated. For most taxpayers under 65 with no disability in the family, the formula is:
AMTC = 25% × [ (annual medical scheme contributions − 4 × annual medical scheme fees tax credit) + other qualifying out-of-pocket expenses − 7.5% × taxable income ]
never below zero. That 7.5%-of-taxable-income threshold is why a modest medical spend often produces no credit at all. You only start benefiting once your qualifying expenses clear that bar. Every extra rand of 4034 expense you find pushes you closer to that line, and sometimes over it. Finding the receipts isn't only about their rand value. It can be the difference between qualifying for the credit and not.
(If you or a dependant has a disability, or you're 65 or older, this threshold falls away and the credit is worked out differently. We cover that in Turning 65: what happens to your medical tax credit and What is the disability medical tax credit?.)
What a smaller, everyday claim looks like
Not everyone has 68 line items and R177,459 sitting in a drawer. Most people's 4034 story is smaller and plainer, but the mechanics are the same. This example uses real numbers to show how it works.
Say a taxpayer under 65, with no disability in the family, has:
- Taxable income: R280,000
- Medical scheme contributions (main member only): R33,600 for the year (R2,800/month)
- Qualifying expenses already reflected as "not recovered" on the certificate (Code 4020): R2,500
Before going through a year of receipts and bank statements, their AMTC works out like this:
- Annual medical scheme fees tax credit (2026 tax year): R364 × 12 = R4,368
- 4 × annual credit = R17,472
- (Contributions − 4 × credit) = R33,600 − R17,472 = R16,128
- Plus other qualifying expenses (R2,500) = R18,628
- Less 7.5% of taxable income (R21,000) = −R2,372
Because the result is negative, the credit floors at zero. On paper, this taxpayer qualifies for no AMTC at all.
Now suppose a reconciliation of their bank and credit-card statements against the scheme's certificate turns up R6,000 of receipts that never made it onto the ITS3(a): a few specialist co-payments, a course of physiotherapy, prescribed medication bought at a retail pharmacy instead of through the scheme. That R6,000 becomes Code 4034.
Re-running the same sum with that added in:
- (R16,128 + R2,500 + R6,000) − R21,000 = R3,628
- AMTC = 25% × R3,628 = R907
Finding R6,000 in receipts that would otherwise have stayed invisible to SARS turned a R0 credit into roughly R907 for this taxpayer. It isn't a fortune. It's real money, recovered from documents that already existed and simply hadn't been reconciled.
How is this money found?
The method is the same whether the total is R907 or R177,459: reconciliation between sources that don't naturally talk to each other.
- Every document gets read and classified. Receipts, invoices, the medical scheme's certificates and claims extract, and a year of bank and credit-card statements are each processed to pull out dates, amounts, payees and descriptions.
- Payments are matched to bank records. A till slip or invoice only counts once it's confirmed against the payment that cleared your account. This is what stops double-counting and catches expenses you paid but never submitted.
- The result is reconciled against the scheme's own certificate. Anything the scheme already listed as "not recovered" stays as Code 4020. Everything else that's a qualifying expense, paid and never claimed, becomes Code 4034, the number nobody hands you.
- Every total is checked arithmetically. Anything uncertain, a blurry receipt, an ambiguous description, a payment that doesn't clearly match, is set aside for a person to confirm before it's included in a final figure.
This is the idea behind SecureSlip. It prepares your supporting documentation. It doesn't give tax advice and it doesn't file anything on your behalf. It turns a year of paperwork into a verified, submission-ready pack, a schedule and cover letter, that you or your tax practitioner can review and file yourselves. It isn't guessing at what SARS will allow either. Every figure is checked by deterministic arithmetic before it reaches you, and the processing happens with private, on-device AI rather than uploading medical and banking documents to a third-party cloud service.
What qualifies for Code 4034?
Broadly, anything you paid for directly and didn't recover from your medical scheme, provided it's a qualifying medical expense:
- GP, specialist, dental and optometrist fees
- Prescribed medicines (over-the-counter items and unprescribed vitamins or supplements generally don't qualify)
- Hospital and theatre fees not covered by the scheme
- Home nursing
- Disability-related expenses and equipment, where applicable
Cosmetic procedures and general wellness purchases without a prescription tied to a diagnosed condition are generally excluded. If you're not sure what documents you'll need, our complete documents checklist walks through what to gather.
The takeaway
Code 4034 exists because your medical scheme can't tell SARS about money it never saw. That makes it the one figure on your ITR12 that depends on you, or someone reconciling on your behalf, doing the legwork. It's why, year after year, it's the most under-claimed of the three medical expense codes.
SARS reviews the Rand value of the medical scheme fees tax credit and related thresholds every year. Always confirm the current tax year's figures at sars.gov.za or with a registered tax practitioner before you rely on them. The percentages and multiples in the AMTC formula above have stayed stable for years, but the underlying credit amounts do move from year to year.
This article is general information, not tax advice. Your eligibility, the qualifying status of specific expenses, and the current tax year's figures should be confirmed with SARS or a registered tax practitioner before you file. If you want a rough sense of what your own documents might be worth, try the free estimator at /calculator, or read /how-it-works to see how the reconciliation process works before you send anything through. You're also welcome to get in touch with questions about your situation.