Best and worst medical aids in South Africa

The latest GTC Medical Aid Survey for 2016 has been released, which compares local medical aid schemes on price across various levels of cover.

According to the latest General Household Survey from Stats SA, only 17.5% of South Africans are covered by medical aid.

Between 2002 and 2015, individuals who were covered by a medical aid scheme increased from 7.3 million to 9.5 million persons.

According to the Council for Medical Schemes’ Annual Report, released in July 2015, 37.55% of all medical aid costs were in-hospital, followed by 23.51% from specialists of which less than 10% was attributable to out-of-hospital services.

This reflects a total of almost 61% of healthcare costs paid for by medical aids were for in-hospital procedures. Expenditure on all health benefits by medical schemes rose by 11.1% in 2014 to reach R124.1 billion.

The GTC makes an admission that trying to compare medical aid schemes in a comprehensive way is virtually impossible due to how various schemes are composed – with a wide array of additional benefits mixed and matched from scheme to scheme.

As such, in its comparative survey, it did not take the different benefits of schemes into account, and rather focused on an “apples with apples” comparison of cost across different plan categories.

The plan categories include:

  • Non-Hospital (out-of-hospital only benefits),
  • Entry Level (in and out-of-hospital benefits within very defined networks and formularies),
  • Hospital Only (in-hospital cover only),
  • Saver (out-of-hospital provided by benefits or savings account),
  • Comprehensive (unlimited above threshold benefit) and
  • Traditional (sub-limits of cover across all benefits).

Finding the best and worst

“It is hardly news that consumers have a vast range of medical scheme plans to choose from,” the group said.

“As always, the correct decision demands that all factors be considered, especially ones’ personal circumstances and needs, which outweigh all other factors.”

GTC assessed medical aid schemes across all categories and managed to rank plans according to their complete costs, risk costs (in-hospital costs), likelihood of support, and the target markets they aim for.

The full document includes a detailed breakdown of the findings, and which plan is best for a single member, a member with a spouse, and for a family with two children.

Below, we have isolated the best and worst entry level and comprehensive medical aid plans for a single member.

The rankings are not purely price-based, but take into account all micro and macro comparisons done by GTC.

Best and worst Entry Level medical aids

# Plan Cost range p.a.
1 CompCare NetworX R4 320 – R20 700
2 FedHealth Blue Door Plus R8 280 – R25 368
3 Sizwe Gomomo Care R8 400 – R22 680
4 Momentum Ingwe Network R4 560 – R20 172
5 Bonitas BonCap R4 416 – R22 008
18 Thebemed Energy Core R14 292 – R39 108
19 Resolution Progressive Flex R22 920
20 Thebemed Energy Medium R17 844 – R41 148
21 Thebemed Energy Open R20 100 – R51 444
22 Commed Standard R32 760 – R38 040

It’s worth noting that many (but not all) entry level plans are salary banded, allowing for cross-subsidisation with those earning higher salaries paying higher premiums for the same benefits as those earning lower salaries.

The table above identifies both student-level premium plans (students earning less than R1,000 per month) and the upper range, earning R15,000+ per month.

Best and worst Comprehensive medical aids

# Plan Total Cost p.a.
1 FedHealth Maxima Standard R35 562
2 Fedhealth Maxima Exec R45 098
3 Discovery Essential Comprehensive R48 362
4 Momentum Extender Any State R48 920
5 TopMed Professional R49 716
12 Liberty Complete Plus R60 678
13 TopMed Rainbow Comprehensive R66 816
14 Keyhealth Platinum R68 535
15 Fedhealth Maxima Plus R72 382
16 Fedhealth Ultimax R103 120

A full breakdown of all medical schemes, including Hospital and Saver plans, can be found in the GTC report.

More on medical aid

Everything you need to know about medical aid schemes in South Africa

The shocking truth about medical aid fraud in South Africa

SA medical scheme payouts

Medical aid fraud is costing South Africa billions

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Best and worst medical aids in South Africa