The Council for Medical Schemes (CMS) has published its 2019/20 annual report, detailing the membership numbers and financial status of South Africa’s open and restricted medical aid schemes.
The CMS regulated 78 registered medical schemes in 2019, a decrease from 79 as a result of a merger between Resolution Health Medical Scheme and Spectramed to form Health Squared Medical Scheme.
These 78 medical schemes comprised of 20 open schemes and 58 restricted schemes. Open schemes accounted for 55.38% of the medical scheme beneficiaries.
These schemes have 4.05 million registered members, serving a total of 8.94 million beneficiaries.
Principal members covered an average of 1.20 dependents, decreasing from 1.32 in 2018. The gender distribution of members was also almost equal in all schemes, although the average age for females was higher with 34.1 versus 31.9 in male members.
Medical scheme members are ageing, with average age across schemes being 33 years, up from 32.8 in 2018.
Based on principal member addresses, approximately 40% of all medical schemes members were in Gauteng, followed by the Western Cape, and KwaZulu-Natal with 15% and 14% respectively.
Biggest schemes in SA
The largest scheme by some margin is Discovery Health, which has 1.342 million members (33% of the total) and 2.795 million beneficiaries (31% of the total).
Among the open schemes, Discovery is followed by Bonitas, with 336,651 members and 718,919 beneficiaries, and Momentum Health, with 156,841 members and 298,829 beneficiaries.
However, including restricted schemes, the second largest medical scheme overall is the Government Employees Medical Scheme (GEMS), which has 713,646 members and 1.856 million beneficiaries.
The South African Police Service Medical Scheme (Polmed) is also in the top five, with 177,430 members and 507,217 beneficiaries.
South Africa’s total medical aid sector is dominated by the top 15 players, which account for 85% of all medical aid members in the country. One third (33%) of these are on Discovery.
Only six schemes have more than 100,000 members, and only 12 have over 100,000 beneficiaries.
The table below outlines the 15 biggest open and restricted schemes.
|Discovery Health||Open||1 342 758||2 795 107|
|Government Employees Medical Scheme||Restricted||713 646||1 856 491|
|Bonitas||Open||336 651||718 919|
|Polmed||Restricted||177 430||507 217|
|Momentum Health||Open||156 841||298 829|
|Bankmed||Restricted||109 392||221 009|
|Medihelp||Open||94 084||205 438|
|LA-Health Medical Scheme||Restricted||81 753||202 860|
|Bestmed Medical Scheme||Open||94 527||197 956|
|Medshield Medical Scheme||Open||80 213||160 886|
|Fedhealth Medical Scheme||Open||74 613||146 961|
|Sizwe Medical Fund||Open||47 321||112 661|
|Platinum Health||Restricted||50 541||86 188|
|Sasolmed||Restricted||29 419||77 984|
|Umvuzo Health Medical Scheme||Restricted||39 422||75 049|