Top 10 Facts About Medical Aids in South Africa

Out of an official population of just more than fifty million people, only eight and a half million South Africans, including primary beneficiaries and their dependents, are members of medical aids. This is only sixteen percent of the population. The majority of people have no option other than to rely upon the overburdened public health system. Often this is to their detriment both financially and healthwise.

2. Of the 97 registered medical aids in South Africa only 26 are classified as open schemes (schemes that anybody can join). The others are all closed schemes, meaning that their members have to be employed by specific companies or organizations. The largest closed scheme is GEMS, which is the medical aid for government employees.

3. A total of four million seven hundred thousand people are served by open medical aids. Closed schemes represent three million seven hundred thousand members.

4. Statistics released by the Council for Medical Schemes reveal that the top ten medical schemes in South Africa, in no particular order, are:

• Discovery Health
• Bonitas
• Medihelp
• SAPS Medical Scheme
• GEMS
• Medshield
• Fedhealth
• Momentum Health
• Sizwe Medical Fund
• Bankmed

5. Out of the top ten schemes listed above, only three are closed schemes: GEMS (they serve government employees), SAPS Medical Scheme (for members of the police), and Bankmed (for employees of the banking industry).

6. The largest medical aids in South Africa (in terms of the number of members) is Discovery Health that boasts approximately two million two hundred thousand members. GEMS, a closed scheme, is the second largest with around one point three million members.

7. The five largest medical scheme administrators handle more than seventy-nine percent of the entire market. Administrators are distinct from trustees and make profits from their services. The big five are:

• V Med Administrators
• Momentum Medical Scheme Administrators
• Discovery Health
• Medscheme Holdings
• Metropolitan Health Corporate

8. Medical aids that handle their own administration, process their own claims, and make payments to members and service providers represent only slightly more than ten percent of the market.

9. Medical schemes in South Africa are overseen by the Council for Medical Schemes, a statutory body reporting to the Minister of Health. This body can help when there are disputes between members and their medical schemes.

10. You can view the list of the Top 10 open medical schemes in South Africa if you click here. © Medical Aid Plan

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NOTES:

Your medical aid quote will include options to suit your pocket. Please ensure that the cover you select is exactly what you need and that you understand exactly what insurance you are buying. Do not hesitate to ask questions about the medical aid or hospital cover you choose.