he Council for Medical Schemes (CMS) has published its 2018/19 annual report, detailing the membership numbers and financial status of South Africa’s open and restricted medical aid schemes.

South Africa is home to 80 different medical aid schemes, 21 of which are open schemes (that anyone is free to join) and 59 restricted schemes (for companies, or specific sectors or industries).

These schemes have 4.02 million registered members, serving a total of 8.87 million beneficiaries.

The largest scheme by some margin is Discovery Health, which has 1.335 million members (33.2% of the total) and 2.79 million beneficiaries (31.5% of the total).

Among the open schemes, Discovery is followed by Bonitas, with 331,955 members and 713,190 beneficiaries, and Momentum Health, with 156,761 members and 298,071 beneficiaries.

However, including restricted schemes, the second largest medical scheme overall is the Government Employees Medical Scheme (GEMS), which has 695,531 members and 1.813 million beneficiaries.

The South African Police Service Medical Scheme (Polmed) is also in the top five, with 175,954 members and 502,996 beneficiaries.

South Africa’s total medical aid sector is dominated by the top 15 players, which account for 84% of all members. One third (33%) of medical aid members in South Africa are on Discovery.

Only six schemes have more than 100,000 members, and only 12 have over 100,000 beneficiaries.

The NHI

The future of medical aid schemes in South Africa have been brought into question amid the government’s plans to roll out National Health Insurance (NHI) over the next few years.

NHI has been deemed a necessity as only a small percentage of South Africans are actually covered by medical aid schemes (15% in total – 8.4% in open schemes).

The Department of Health envisions a diminished role for medical aids in the country as the NHI takes over the primary healthcare cover for the greater population.

With a targeted end date in 2026, the department has clarified that medical aids will continue to operate alongside the NHI in the interim – however, they are only allowed to cover healthcare services that are not covered by the NHI itself.

This has been an ambiguous stipulation in the NHI regulations which medical aid groups have called for clarity over, particularly as there has been no documentation or published position on what the NHI will cover.

According to Discovery and similar private schemes, its reading of the regulations is that medical aids will remain an option for South Africans who choose not to make use of the NHI at all, and thus will function as normal.