Finance

The 5 biggest medical aid schemes in SA – what they offer, and how much they cost in 2019

Staff Writer

 ·13 Jan 2019

There are currently just under 8.9 million South Africans covered by registered medical aid schemes, according to the latest annual report from the Council of Medical Schemes (CMS) – most belonging to the 10 largest.

South Africa’s 10 biggest medical aid schemes comprise six open plan medical aids (open to everyone) and four restricted plans (only available to specific group), which altogether account for almost 80% of the entire medical aid market.

With so many options from each individual plan, each offering a different set of terms and conditions, it’s easy to get bogged down by the clutter, and focus solely on price.

BusinessTech delved into the various products offered by the biggest open schemes in the country to try and simplify what sets each plan apart – and included the plan charges for 2019, because ultimately price plays the biggest role.

This is not a comprehensive review of each individual plan offered by the medical aids, and if you’re looking to change schemes, upgrade or downgrade, you should read through the information provided by the respective groups to ensure your health needs are covered.

What’s the same

By law, South African medical schemes are non-profit trusts, owned by their members. In this sense, they are all functionally the same – members’ contributions are pooled and used to pay relevant medical costs where necessary, while keeping a legislated surplus to prevent the scheme from collapsing.

Some medical plans have a savings option, which creates a savings pool from a member’s monthly contributions which is for exclusive use by that member.

Medical aid schemes are also required by law to cover a set list of chronic illnesses, known as the Prescribed Minimum Benefits (PMB). This is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected.

Beyond this, medical aid schemes are free to differentiate themselves through their product offerings, usually targeting specific demographics.

Things like annual limits, specialised benefits, family cover, day-to-day coverage and networked doctors and hospitals all vary across the different plans – both internally across a single group’s plans, and from company to company.

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Discovery

Discovery is by far the largest open medical aid scheme in the country, accounting for 56% of all beneficiaries in that sector and 31% of the overall market. According the the CMS report, it currently has just under 2.8 million beneficiaries.

• Offers 27 plans Across 7 scheme categories.
• No overall limit for hospital cover on any Discovery Health Medical Scheme plan. You can go to any private hospital on most plans;
• Access to screening and prevention benefits that cover tests to detect early warning signs of serious illness;
• Above Threshold Benefit (ATB) that gives further day-to-day cover once the Annual Threshold has been reached;
• Day-to-day Extender Benefit (DEB) for essential healthcare services in its network once medical savings are used up;
• Works in conjunction with the Vitality rewards programme, as well as the coming Discovery Bank.

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Bonitas

Bonitas is the second largest open medical aid scheme, but the third largest overall (below the government’s GEMS). It accounts for 15% of the open scheme market with 731,500 beneficiaries, representing 8.3% of total market share.

• Offers 13 plans across 9 scheme categories.
• Cover for 27 to 60 chronic conditions and free medicine delivery;
• Free cover for your fourth and subsequent children so you only pay for a maximum of three children;
• Has Managed Care programmes to help manage chronic conditions including cancer, mental health, HIV/AIDS and diabetes;

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Momentum

Momentum Health is the third largest open medical aid scheme, and the fifth largest overall, below the police medical scheme, POLMED. The group has 284,400 beneficiaries, which is 5.8% of the open sector, and 3.2% of the total market.

• Offers 33 plans Across 6 scheme categories.
• No overall annual limit for hospitalisation;
• Covers 26 to 62 chronic conditions;
• Offers highly flexible plans with the option of state, networked or open hospitals;
• Health platform benefit for preventative care and screening;
• Offers additional products like HealthSaver to help make medical saving easier;
• Works in conjunction with the Momentum Multiply rewards programme.

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BestMed

BestMed is the fourth largest open medical aid scheme in the country, and the seventh largest overall, ranked below the restricted BankMed scheme. It has just under 200,000 beneficiaries, and accounts for 4.05% of the open market, and 2.26% of the total market.

• Offers 11 plans Across 3 scheme categories.
• Self-administered which means more of your money goes towards benefits and less towards administration;
• No self-payment gaps;
• Fewer co-payments;

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MediHelp

MediHelp trails closely behind BestMed as the fifth largest open medical scheme, and the eighth largest overall. It also has just under 200,000 beneficiaries – just 901 fewer than BestMed – accounting for 4.03% of the open market, and 2.25% of the overall market.

• Offers 7 plans Across 4 scheme categories;
• Full cover for 270 PMBs and 26 chronic conditions;
• No overall limit on hospital cover;
• Unlimited cover for trauma and emergencies;
• On Prime options, you only pay for 2 children – the rest are covered for free;
• Children can remain dependents until they are 26;
• Access to online wellness programmes and emergency app.

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Read: Leaked document shows the scary future of NHI and medical aids in South Africa