Before you start

A valid passport plus a current work, study, retirement, or residence visa/permit
A South African bank account to pay monthly contributions by debit order (it may be someone else's account)
Proof of address and personal/dependant details for the application
A realistic monthly budget — private cover is the norm and costs from a few hundred to several thousand rand a month

Step-by-step

1
Understand the two-tier system and plan to go private
Roughly 80% of South Africans rely on the public sector and only about 16% have private cover. Public care is free or very cheap and does not discriminate by immigration status, but it is overcrowded with long waits for non-urgent care. As a foreigner you will almost certainly use private care day-to-day; treat the public system mainly as a backstop and for serious emergencies at tertiary hospitals.
OnlineWho: YouBackground research, 1-2 hours
2
Choose local medical aid vs international/expat insurance
'Medical aid' (a medical scheme regulated by the Council for Medical Schemes) is community-rated, must accept all applicants, covers Prescribed Minimum Benefits, and settles bills directly with providers — the standard long-term choice. The big open schemes are Discovery Health, Momentum and Bonitas. International plans (Cigna Global, Allianz Care, AXA, Bupa Global) give worldwide cover and are popular for shorter stays, frequent travellers, or to bridge the gap on arrival. Many newcomers start on an international plan, then switch to local medical aid once settled.
OnlineWho: You (or via a broker)A few days to compare quotes
3
Join a scheme and budget for waiting periods + PMBs
Foreigners can join the same plans on the same terms as locals with a valid visa and an SA bank account. Pick a hospital plan (cheapest, covers in-hospital events) or a comprehensive plan (adds day-to-day cover via a savings account). Expect a 3-month general waiting period and up to 12 months on pre-existing conditions before you can claim non-PMB benefits — so apply early. Prescribed Minimum Benefits (a fixed list of ~270 conditions, 27 chronic conditions, plus emergencies) must be covered in full at the scheme's designated providers regardless of plan tier.
OnlineWho: You / chosen schemeCover starts the 1st of a chosen month; waiting periods 3-12 monthsFrom ~R1,350/mo (~US$80) basic to R3,000-15,000/mo (~US$180-900) comprehensive, main member
4
Register with a GP and know your private hospitals
Find a private GP near home (or use in-store clinics at Clicks and Dis-Chem) for routine care; a cash GP visit is roughly R375-R600. For anything serious, the leading private hospitals are Netcare Christiaan Barnard Memorial, Mediclinic Cape Town, and Life Vincent Pallotti — all excellent, with short waits. Groote Schuur and Tygerberg are the top public tertiary hospitals and are world-class for emergencies and complex cases.
In personWho: YouSet up in your first weeksPrivate GP ~R375-R600 (~US$23-36) cash per visit
5
Save emergency numbers and find your pharmacy
For an ambulance dial 10177, or 112 from any mobile (routes you to the nearest service). Private services ER24 (084 124) and Netcare 911 (082 911) are faster and better-equipped than stretched public ambulances — but in an emergency they may ask which medical aid you are on, so keep your membership number and a card on your phone. Pharmacies (Clicks, Dis-Chem) are everywhere, fill scripts, and many medicines are sold over the counter. Hospitals run backup generators during load-shedding, though smaller clinics and pharmacies can be affected.
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Documents you’ll need

Valid passport and current visa/permit (work, study, retirement, or residence)
South African bank account details for the debit order
Completed medical-aid application with full medical history of you and dependants
Medical-aid membership card/number stored on your phone for emergencies

Things most newcomers don’t know

The gap between the two tiers is enormous, so the realistic plan for any expat is private cover from day one — do not assume you'll just 'use the public system'.

Public facilities are free but serve ~80% of the population and are overcrowded with long waits; private care is fast and world-class but you must pay or be insured. Arriving without cover leaves you exposed to large out-of-pocket private bills.

Source: Expatica / Statista (private sector covers ~16% of the population)

Choose deliberately between local 'medical aid' and international insurance, and apply early because of waiting periods.

Medical aid is community-rated, must accept you, settles bills directly with hospitals, and covers Prescribed Minimum Benefits in full — but imposes a 3-month general wait and up to 12 months on pre-existing conditions. International plans cover you worldwide and can start cleaner on arrival, which is why many newcomers bridge with one, then switch.

Source: Council for Medical Schemes (PMBs); Expatica

Cape Town's private hospitals are a genuine medical-tourism destination, so quality is not the worry — affordability is.

Hospitals like Netcare Christiaan Barnard Memorial, Mediclinic Cape Town and Life Vincent Pallotti draw international patients (Cape Town hosted the world's first heart transplant in 1967). Procedures can cost a fraction of US prices, which is great if insured but a real bill if you're not.

Source: Cape Town Tourism; MedicalTourism.com

In a real emergency, public Groote Schuur or Tygerberg can be the right call — and always keep your medical-aid and ambulance details to hand.

Those tertiary hospitals are excellent for trauma and complex specialist care despite the queues for routine visits. Private ambulances (ER24, Netcare 911) are faster but may ask which scheme you're on; having your membership number ready avoids delays when seconds count.

Source: Western Cape Government / Groote Schuur Hospital; Netcare 911 / ER24

Common mistakes to avoid

Arriving with no cover and assuming the public system is a free, fast safety net — it is free but overcrowded, and a private emergency without insurance can be ruinously expensive.
Confusing cheap 'health insurance' or a hospital cash plan with a full medical aid — insurance pays limited fixed amounts and can refuse you, whereas a medical scheme must accept you and covers PMBs.
Joining at the last minute and being caught by the 3-month general wait or the 12-month pre-existing-condition wait, so you pay contributions but can't yet claim.
Not storing your medical-aid membership number, plan details and a private-ambulance number (ER24 084 124, Netcare 911 082 911) on your phone before you need them in an emergency.