12 Facts You Should Know About SA Medical Aid Schemes

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Are you shopping around for medical aid in South Africa? Here are 12 facts that may help you make an informed choice.

  1. There are currently 22 open medical aid schemes in South Africa, compared to the 144 registered with the Council for Medical Schemes (CMS) in 2000. You can find snapshots of each scheme on the CMS website, or you can browse through the facts and figures of the "Top 10" medical aid schemes in South Africa here.
  2. An easy way to determine whether a medical aid scheme is financially sound, and has sufficient funds to settle claims, is by its Global Credit Rating (GCR). You can download 2017 ratings and reports, and view the latest ratings for 16 of the biggest South African medical aid schemes on the GCR website.
  3. Although private health care costs are exceptionally high and continuing to rise (they outstripped inflation by 5% in 2016), less than 20% of South Africans are members of medical aid schemes. Don’t become a statistic and fall into a debt trap. The sooner you sign up with a medical aid scheme, the better.
  4. If you are over the age of 35 or 40 (depending on the scheme) and have, at any time, been without medical aid, you may be required to pay a late joiner fee. Penalties are based on the number of years you’ve been without cover, and can be up to 1.75 times the monthly contribution amount.
  5. With 2.7 million beneficiaries and a market share of 53%, Discovery Health is the largest open medical aid scheme in the country. It has a R1 billion financial surplus; average principal member and beneficiary ages are a comparatively young 44 years and 34 years, respectively, and it has retained a paying ability GCR of AA+ in 2017.
  6. In 2017, Fedhealth has cash reserves of 35.65%, a figure ranked amongst the highest in the industry. It has also earned a GCR of AA- for the 10th year in a row.
  7. Medical aid brokers offer free advice as to the best schemes and options for your requirements based on available budget. When you join a broker-recommended scheme, you don’t pay a cent. The medical aid provider pays a fixed monthly commission, provided the broker is contracted to the scheme.
  8. Medical journal Lancet predicts a 78% increase in the number of cancer cases by 2030. Factor in a spike in chronic conditions – in 2016, 3.85 million adult South Africans were living with diabetes - and it’s clear medical aid cover is a necessity.
  9. Private healthcare fees are unregulated. Doctors and specialists can charge what they want. Without medical aid, you’ll have to pay for treatment and procedures out of your own pocket, or be prepared to sit in long queues at state-owned hospitals and clinics.
  10. Genesis Medical Scheme increased its average monthly contributions by just 4.7% in 2017, the lowest in the industry. The rand value of the increases were between R80 and R100 per month, per adult member. The next best medical scheme was Medshield, with an average increase of 9.6%.
  11. All medical aid schemes have to retain at least 25% of contributions as cash reserves. This is known as the scheme solvency ratio. Medshield (50%), Fedhealth (35.65%) and Bonitas (26.1%) all have cash reserves over the prescribed limit.
  12. The top 6 medical aid schemes, according to membership base, are Discovery Health, Bonitas, Momentum Health, Medihelp, Medshield and Fedhealth.

At IFC Consultants, we offer informed, objective advice about South African medical aid schemes, and can assist you in joining the scheme that best suits your needs and budget. Contact us for more information or to discuss your needs.