5 biggest medical aid schemes in SA – what they offer and how much they cost in 2023

There are currently 8.94 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 ten largest plans.

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

With so many options from each plan offering different terms and conditions, it’s easy to get intimidated by the clutter and focus solely on price.

BusinessTech looked into the various products offered by the biggest open schemes in the country to try and simplify what sets each plan apart.

We also included the plan charges for 2023 because, ultimately, price plays the most significant role.

This is not a comprehensive review of each plan offered by the medical aids. 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.

The basics

By law, South African medical schemes are non-profit trusts their members own.

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 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 set of defined benefits ensures 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 – internally across a single group’s plans and from company to company.

The prices below reflect the price adjustments which will come into effect from 1 April 2023.

Discovery 

Discovery continues to dominate South Africa’s medical aid scheme sector, with over 1.3 million members and 2.7 million beneficiaries.

• Offers 25 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;
• You get comprehensive benefits for maternity and early childhood that cover certain healthcare services before and after birth;
• On selected plans, the group pays your day-to-day medical expenses from the available funds allocated to your Medical Savings Account (MSA), and,
• Works in conjunction with the Vitality rewards programme, as well as the coming Discovery Bank.

Bonitas

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.

• Offers 15 plans across 5 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;
• Offers several benefits such as a contraceptives benefit of R1,830 (for women aged up to 50) and childcare (screenings and paediatrician visits); and
• Has Managed Care programmes to help manage chronic conditions, including cancer, mental health, HIV/AIDS and diabetes;

Momentum Health

Momentum Medical Scheme is the third largest open scheme, with 153,064 and 293,884 beneficiaries.

• Offers 35 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; and
• Works in conjunction with the Momentum Multiply rewards programme.

Bestmed

Bestmed is the fourth biggest open medical aid scheme behind the restricted LA-Health Medical Scheme. Bestmed has around 96,489 members and 202,386 beneficiaries.

• Offers 13 plans Across 3 scheme categories.
• Self-administered, which means more of your money goes towards benefits and less towards administration;
• No self-payment gaps; and
• Fewer co-payments;

Medihelp

Medihelp falls in 5th as the biggest open-scheme, just behind Bestmed with 90,442 members and 197,621 beneficiaries.

• Offers 11 plans Across 8 scheme categories;
• Full cover for 271 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; and
• Access to online wellness programmes and emergency app.

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