5 biggest medical aids in South Africa – what they offer and how much they cost right now

According to the latest annual report from the Council of Medical Schemes (CMS), 9.04 million South Africans are currently covered by registered medical aid schemes, most of whom belong to the ten largest plans.

South Africa’s ten largest medical aid schemes consist of six open-plan medical aids (available to everyone) and four restricted plans (only available to specific groups), which make up almost 80% of the entire medical aid market. With each plan offering different terms and conditions, it’s easy to feel overwhelmed by the options and focus solely on price.

Considering this, BusinessTech examined the various products offered by the country’s largest open schemes to simplify what distinguishes each plan.

We also included the plan charges for 2024 because, ultimately, price plays the most significant role. This is not a comprehensive review of each plan offered by the medical aids.

If you are considering changing schemes, upgrading, or downgrading, you should carefully review the information provided by the respective groups to ensure your health needs are covered.

South African medical schemes are non-profit trusts owned by their members as per the law.

They all function in a similar manner, pooling members’ contributions to cover medical costs and keeping a surplus to prevent collapse.

Some plans have a savings option, allowing members to create a personal savings pool from their contributions.

By law, medical aid schemes must cover a set list of chronic illnesses known as the Prescribed Minimum Benefits (PMB), ensuring access to minimum health services for all members, regardless of their selected benefit option.

Beyond this, schemes differentiate themselves through product offerings, such as annual limits, specialized benefits, family coverage, day-to-day coverage, and networked doctors and hospitals.

These offerings can vary both within a single group’s plans and from company to company.

Top 5 medical aid schemes

As of the end of 2023, Discovery remains the largest medical scheme in the country, with 1.36 million members and close to 2.8 million beneficiaries.

There has been an increase from 1.33 million to 2.7 million in the past year. The majority of the country’s medical aid members are subscribed to open (O) schemes, which account for 2.38 million members and 4.86 million beneficiaries.

About 58% of these totals are attributed to Discovery.

Restricted (R) medical schemes, which provide industry-specific or company-specific coverage, make up the remaining numbers with 1.75 million members and 4.2 million beneficiaries.

The Government Employee Medical Scheme (GEMS) is the largest player in this category, with 805,500 members and 2.14 million beneficiaries, making up roughly 46% and 51% of restricted members and beneficiaries, respectively.

Following the signing of the National Healthcare Insurance (NHI) Bill in 2024, there has been understandable anxiety about the future of medical aid.

The main cause of anxiety among South Africans stems from the way the new laws deal with medical aid, raising questions about what will happen to benefits and whether or not medical aid will need to be cancelled.

Section 33 states that once NHI is fully implemented, medical schemes will be able to cover only those services that are not covered by NHI.

This implies that medical scheme cover will be replaced by the NHI at that point in time.

However, South Africa’s biggest medical aids—Discovery and Bonitas—have said that it will take many years to roll out NHI, and only once it is fully implemented will it impact medical aids.

“We want to reassure all medical aid members that it’s ‘business as usual’,” said Bonitas.

The prices below reflect the prices effective 1 April 2024.

Discovery 

Discovery continues to dominate South Africa’s medical aid scheme sector, with 1.36 million members and 2.8 million beneficiaries.

• Offers 22 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,
• It works in conjunction with the Vitality rewards programme and Discovery Bank.

Bonitas

The second largest open scheme in the country is the Bonitas Medical Fund, which has increased it’s beneficiaries to just shy of 730,000.

• 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) 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 156,044 and 296,119 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 now has over 100,000 members and 228 968 beneficiaries.

• Offers 14 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 90,871 members and 198,501beneficiaries.

• 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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