These are the biggest medical aid schemes in South Africa right now

 ·20 Oct 2022

The Council for Medical Schemes has published its industry report for 2021, detailing the membership numbers and financial status of South Africa’s open and restricted medical aid schemes.

The CMS regulated 75 registered medical schemes in 2021, a decrease from 76 in 2020.

The group noted that South Africa has seen consistent consolidation in the medical aid market over the last 20 years, driven by voluntary mergers of schemes.

South Africa has seen a decline in schemes from 144 in 2000, to the reported 75 schemes that were in operation in 2021, with the most significant decline occurring between 2007 and 2010. Of the reported 75 schemes in 2021, 18 are open, and 57 are restricted.

While the reported figure for the year is 75 schemes, the council noted that Hosmed Medical Scheme amalgamated with Sizwe Medical Fund, and Quantum Medical Aid Society amalgamated with Discovery Health Medical Scheme, bringing the total number of active schemes to 73 as of December 2021.

The sector as a whole saw a decline in the number of medical schemes, but the distribution of medical schemes by scheme size has also shown a significant shift, the council said.

Small schemes surpassed medium and large schemes from 2002 to 2013. While the number of medium schemes increased slightly over the last few years, the number of large schemes declined.

The number of beneficiaries covered by medical schemes has remained stagnant in the past decade, not surpassing the nine million mark. Medical schemes served 8.94 million beneficiaries in 2021, up slightly from 8.9 million in 2020, but down from the high of 8.99 million in 2019.

The only significant increase in the environment arose following the introduction of GEMS in 2006. In 2021, GEMS surpassed the 700,000 mark, with 773,512 principal members, and its beneficiaries now exceed 2 million, at 2,036,102.

The percentage of beneficiaries covered by medical schemes, expressed as a percentage of the population in the country, declined during the period under review from 16% in 2000 to 14.86% in 2021.

Open schemes account for more than half of the medical scheme’s population (54.03%), while restricted schemes accounted for the balance (45.97%) in 2021.

Biggest medical schemes

According to the CMS, medical schemes in South Africa have 4,059,597 million members, with 8,945,053 beneficiaries, up marginally – 0.92% and 0.55%, respectively – from last year.

Open schemes account for 2,351,958 members and 4,835,649 beneficiaries, with the balance subscribed to restricted schemes.

Discovery continues to dominate South Africa’s medical aid scheme sector, with over 1.3 million members and 2.7 million beneficiaries. Notably, amid the general decline of beneficiaries experienced among open schemes in South Africa, Discovery’s numbers remained flat, losing only 106 beneficiaries.

The second largest open scheme in the country is the Bonitas Medical Fund, which saw a slight drop of 0.3% in beneficiaries to just shy of 715,000. Membership numbers were up 1.4%, however.

The Government Employees Medical Scheme remains the biggest restricted scheme with 1.92 million beneficiaries, also making it the second largest in the country overall.

The table below outlines the 20 biggest medical schemes in the country, ranked by the number of beneficiaries.

Scheme Type Members Beneficiaries
Discovery Health Open  1 333 237 2 764 994
Government Employees Medical Scheme Restricted 737 796 1 924 569
Bonitas Medical Fund Open 335 425 714 989
South African Police Service Medical Scheme (POLMED) Restricted 175 728 504 758
Momentum Medical Scheme Open 153 064 293 884
Bankmed Restricted 107 563 219 807
LA-Health Medical Scheme Restricted 88 145 219 725
Bestmed Medical Scheme Open 96 489 202 386
Medihelp Open 90 442 197 621
Medshield Medical Scheme Open 77 146 154 459
Fedhealth Medical Scheme Open 76 215 148 189
Sizwe Hosmed Medical Fund Open 47 575 112 802
Platinum Health Restricted 51 672 90 532
Sasolmed Restricted 29 229 77 655
Umvuzo Health Medical Scheme Restricted 38 915 75 724
SAMWUMed Restricted 34 520 75 547
Profmed Restricted 35 667 74 630
Keyhealth Open 32 747 67 709
Hosmed Medical Aid Scheme Open 21 125 54 253
Nedgroup Medical Aid Scheme Restricted 27 083 48 641

Read: Discovery announces price change for 2023 – and new benefits

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