Your medical scheme's tax certificate, or your IRP5, shows a string of codes: 4005, 4020, 4034. Each one means something different, and mixing them up is an easy way to under-claim without knowing it.
This guide covers what each code means, where the numbers come from, and why code 4034 is the one most South Africans lose money on.
Where do these codes come from?
Every year your medical scheme sends you a tax certificate, officially called an ITS3(a). It summarises what you paid in and what the scheme paid out on your behalf. Your tax practitioner, or you if you file your own ITR12, transfers figures from that certificate into specific fields on your return. Those fields are the codes.
The codes aren't random labels. Each one answers a different question:
- 4005 asks: how much did you pay to belong to the scheme?
- 4020 asks: of what you paid out of pocket, how much has the scheme already told SARS about?
- 4034 asks: how much did you pay out of pocket that nobody has told SARS about yet?
Get comfortable with that last question. It usually needs the most work, and it pays off the most.
The three codes at a glance
| Code | What it represents | Where the figure comes from | Typical effort to get right | |---|---|---|---| | 4005 | Total medical scheme contributions paid for the year | Printed directly on your ITS3(a) certificate | Low: copy the number | | 4020 | Qualifying medical expenses already reflected as "not recovered" on the scheme's own certificate | Printed directly on your ITS3(a) certificate | Low: copy the number | | 4034 | Additional qualifying expenses paid out of pocket that do not appear on any medical scheme certificate | You gather and reconcile it yourself from receipts, invoices and bank statements | High: manual reconciliation |
Notice the pattern. Codes 4005 and 4020 are both handed to you, printed on the one certificate your scheme sends every year. Code 4034 is different. Nobody hands it to you. It only exists if you go looking for it.
Code 4005: what you paid for cover
This is the simplest of the three. It's the total you paid in medical scheme contributions for the year: your monthly premiums, added up. It has nothing to do with what you spent on doctors, medicine or hospital bills. It's the cost of belonging to the scheme.
This figure feeds into the Medical Scheme Fees Tax Credit, the fixed monthly rebate you get just for having cover. It's also one of the inputs into the Additional Medical Expenses Tax Credit calculation, which we cover below.
Code 4020: what your scheme already told SARS
Every year, some of what you spend on medical expenses doesn't get reimbursed by your scheme. Maybe you paid a specialist's account in full, or a portion of a hospital bill wasn't covered. Your scheme already knows about this, because the claims passed through its system even though it didn't pay out. That "not recovered" figure is summarised and printed as code 4020 on your certificate.
Your scheme has already done the reconciliation and put it on paper. So code 4020 is low-risk and low-effort. You, or whoever prepares your return, transfer the number across.
Code 4034: what you have to find yourself
This is where it gets interesting. It's also where most people lose money.
Code 4034 covers qualifying medical expenses you paid directly, out of your own pocket, that never went near your medical scheme's claims system. Think of the physiotherapist you paid cash, the chronic prescription you settled at a small pharmacy, or the dentist invoice you paid by EFT and never submitted as a claim. None of that appears on your ITS3(a) certificate, because your scheme never saw it.
Unlike 4005 and 4020, nobody hands you this figure. You have to reconstruct it yourself. In practice that means:
- Pulling every medical receipt and invoice for the tax year.
- Matching each one to the bank or credit card statement that proves you paid it.
- Cross-checking against your scheme's certificate and claims extract to confirm the expense isn't already counted under 4020.
- Totalling only the qualifying items: GP, specialist, dentist and optometrist fees, prescribed medicine, hospital and theatre fees, home nursing, and qualifying disability-related costs. Over-the-counter items, unprescribed supplements and cosmetic procedures don't count.
That's a lot of manual reconciliation, which is why code 4034 is so often understated or skipped. For a deeper look at what qualifies, and what one real reconstruction turned up, see SARS code 4034: what it lets you claim back. If a drawer full of receipts sounds familiar, our post on the shoebox problem explains why this happens to almost everyone, not just the disorganised.
A worked example
Let's run a hypothetical taxpayer through all three codes. Thandi is 42, not disabled, belongs to a medical scheme with her spouse as a dependant, and earns a taxable income of R550,000 for the year.
Her figures for the year:
- Code 4005: total contributions paid, R66,000 (R5,500/month)
- Code 4020: qualifying expenses already on her scheme's certificate, R12,400
- Code 4034: additional expenses reconstructed from receipts and bank statements, not on any certificate, R18,750
Because Thandi and her spouse are both under 65 with no disability, her Additional Medical Expenses Tax Credit (AMTC) uses the standard formula:
AMTC = 25% × [(annual contributions − 4 × annual MTC) + other qualifying expenses − 7.5% × taxable income]
Working through it:
- Annual Medical Scheme Fees Tax Credit: (R364 + R364) × 12 = R8,736
- 4 × annual MTC = R8,736 × 4 = R34,944
- Contributions minus that: R66,000 − R34,944 = R31,056
- Other qualifying expenses: R12,400 (code 4020) + R18,750 (code 4034) = R31,150
- 7.5% of taxable income: 7.5% × R550,000 = R41,250
- Inside the brackets: R31,056 + R31,150 − R41,250 = R20,956
- AMTC: 25% × R20,956 = R5,239
On top of that, Thandi still gets her R8,736 Medical Scheme Fees Tax Credit regardless. That credit isn't affected by the 7.5% threshold at all.
Notice how much of the final number depends on code 4034. Without that R18,750, the bracket would only have been R2,206, and the AMTC would have dropped to roughly R552. That's a difference of nearly R4,700, just because those out-of-pocket receipts were never reconciled.
When does the formula change?
If Thandi, her spouse, or a dependant had a qualifying disability confirmed via an ITR-DD form completed by a registered medical practitioner, or if she were 65 or older, the calculation changes. A higher 33.3% rate applies, the 4 × MTC becomes 3 × MTC, and the 7.5%-of-income threshold falls away. It's worth checking if your circumstances have shifted. We cover this in more detail in Turning 65: what happens to your medical tax credit and What is the disability medical tax credit?
Getting your own numbers right
Codes 4005 and 4020 are the easy part. They're printed for you. Code 4034 is the part that rewards effort: gathering receipts, matching them to bank statements, and reconciling against what your scheme has already reported. Not sure what documents you need? Our complete documents checklist walks through what to collect.
This is the reconciliation work SecureSlip automates. We take your receipts, invoices, medical scheme certificates and bank statements for the year, and process them with private, on-device AI. We cross-check every AI-read figure against deterministic arithmetic and against your scheme's own certificate, then hand back a submission-ready pack that separates what's already counted (4020) from what's new (4034). Anything uncertain gets flagged for a human reviewer before it's finalised.
This article is general information, not tax advice. The R364 and R246 monthly Medical Scheme Fees Tax Credit figures above are for the 2024/2025 tax year. SARS reviews these amounts annually, so confirm the current year's figures at sars.gov.za or with a registered tax practitioner before you file. The percentages and thresholds in the AMTC formula (25%, 33.3%, 7.5%, and the 4×/3× multiples) are long-standing, but it's worth checking nothing has changed for the year you're filing. SecureSlip prepares supporting documentation for your claim. You or your tax practitioner remain responsible for reviewing and submitting your return.
Want a sense of what your own figures might look like? Try the free estimator at /calculator, or read how it works to see the full process. Have questions about your situation? Get in touch.