{"id":667509,"date":"2023-02-26T17:00:03","date_gmt":"2023-02-26T15:00:03","guid":{"rendered":"https:\/\/businesstech.co.za\/news\/?p=667509"},"modified":"2023-02-27T08:17:45","modified_gmt":"2023-02-27T06:17:45","slug":"5-biggest-medical-aid-schemes-in-sa-what-they-offer-and-how-much-they-cost-in-2023","status":"publish","type":"post","link":"https:\/\/businesstech.co.za\/news\/lifestyle\/667509\/5-biggest-medical-aid-schemes-in-sa-what-they-offer-and-how-much-they-cost-in-2023\/","title":{"rendered":"5 biggest medical aid schemes in SA – what they offer and how much they cost in 2023"},"content":{"rendered":"

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) \u2013 most belonging to the ten largest plans.<\/p>\n

South Africa\u2019s 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.<\/p>\n

With so many options from each plan offering different terms and conditions, it\u2019s easy to get intimidated by the clutter and focus solely on price.<\/p>\n

BusinessTech looked into the various products offered by the biggest open schemes in the country to try and simplify what sets each plan apart.<\/p>\n

We also included the plan charges for 2023 because, ultimately, price plays the most significant role.<\/p>\n

This is not a comprehensive review of each plan offered by the medical aids. If you\u2019re 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.<\/p>\n

The basics<\/strong><\/p>\n

By law, South African medical schemes are non-profit trusts their members own.<\/p>\n

In this sense, they are all functionally the same \u2013 members\u2019 contributions are pooled and used to pay relevant medical costs where necessary while keeping a legislated surplus to prevent the scheme from collapsing.<\/p>\n

Some medical plans have a savings option, which creates a savings pool from a member\u2019s monthly contributions for exclusive use by that member.<\/p>\n

Medical aid schemes are also required by law to cover a set list of chronic illnesses, known as the Prescribed Minimum Benefits (PMB).<\/p>\n

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.<\/p>\n

Beyond this, medical aid schemes are free to differentiate themselves through their product offerings, usually targeting specific demographics.<\/p>\n

Things like annual limits, specialised benefits, family cover, day-to-day coverage and networked doctors and hospitals all vary across the different plans \u2013 internally across a single group\u2019s plans and from company to company.<\/p>\n

The prices below reflect the price adjustments which will come into effect from 1 April 2023.<\/p>\n

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Discovery\u00a0<\/strong><\/p>\n

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Discovery continues to dominate South Africa\u2019s medical aid scheme sector, with over 1.3 million members and 2.7 million beneficiaries.<\/p>\n