Major South African Medical Schemes, and What They Offer
A new year brings higher prices and some big changes to South Africa’s medical aid schemes. Below is what the five biggest schemes in the country have on offer for 2020 – and how much they’re charging.
South Africa is home to 80 different medical aid schemes, with 4.02 million registered members, serving a total of 8.87 million beneficiaries.
Among these schemes, 21 are open schemes (that anyone is free to join) and 59 restricted schemes (for companies, or specific sectors or industries).
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.
This is followed by BestMed (93,635 members and 197,088 beneficiaries) and MediHelp (92,884 members and 201,944 beneficiaries).
Medical aid users would have noted price increases across all medical schemes in 2020 – though some schemes have raises prices more than others.
Discovery’s medical plan increases ranged between 9% and 11%, while Bonitas saw an overall weighted increase of 9.9% among its schemes. Momentum’s weighted increase was 8.2%, and BestMed saw price increases of 8.9% among options.
MediHelp’s price increases average at 11.9%.
What’s the same
By law, South African medical schemes are non-profit trusts, owned by their members. In this sense, they are all functionally the same – members’ contributions are pooled and used to pay relevant medical costs where necessary, while keeping a legislated surplus to prevent the scheme from collapsing.
Some medical plans have a savings option, which creates a savings pool from a member’s monthly contributions which is for exclusive use by that member.
Medical aid schemes are also required by law to cover a set list of chronic illnesses, known as the Prescribed Minimum Benefits (PMB). This is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected.
Beyond this, medical aid schemes are free to differentiate themselves through their product offerings, usually targeting specific demographics.
Things like annual limits, specialised benefits, family cover, day-to-day coverage and networked doctors and hospitals all vary across the different plans – both internally across a single group’s plans, and from company to company.
This article not a comprehensive review of each individual plan offered by the medical aids, and if you’re 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.
- Offers 29 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;
In 2020 Discovery said that co-payments and deductibles will be increased by 9.5%. It added that benefit limits will be increased by 9.5% with the exception of things like the oncology threshold, international travel benefit, among others, where there is no increase for 2020.
From 1 January 2020, certain formulary changes and chronic drug amount updates will be applied, and the the Day-to-day Extender Benefit will now cover video call consultations with a network GP as well as pharmacy clinic consultations in the group’s wellness network. More information on the major Discovery changes can be read here.
One of the biggest changes to Discovery in 2020 is the Vitality programme – more specifically, the Vitality Rewards Points, which will be converted into the group-wide Discovery Miles.
You can read more about the changes being made to the Vitality points system here.
- Offers 13 plans across 9 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;
- Has Managed Care programmes to help manage chronic conditions including cancer, mental health, HIV/AIDS and diabetes;
Key changes for Bonitas in 2020 come by way of enhances maternity benefits and support, additions to the Wellness Extended benefit, the introduction of a pharmacy network, as well as changes to co-payments and hearing-aid cycles.
Currently the Wellness Extender benefit can be accessed after competing a wellness screening test. It can be used for consultations and treatment with a GP, physiotherapist, dietician or biokineticist, or to participate in a stop smoking programme. In 2020, the benefit will be extended to include blood tests and x-rays.
With the new pharmacy network, members will be able to access chronic, acute, over-the-counter and oncology medicine from a network of providers which will avoid having to pay additional dispensing fees.
Expecting mothers will gain access to lactation specialists, and also get major discounts from Baby City, as well as a mother and child support network.
A full breakdown of the major changes to Bonitas for 2020 can be found here.
- Offers 35 plans across 6 scheme categories.
- No overall annual limit for hospitalisation;
- Covers 26 to 62 chronic conditions – with the base 26 conditions carrying no annual limit;
- 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;
- Works in conjunction with the Momentum Multiply rewards programme.
Aside from price increases, 2020 changes for Momentum Health include the introduction of the Evolve option, and the falling away of the Impact option.
The major medical benefits on the Evolve option differ to the benefits that were available on the Impact option. For example, there is no longer an annual limit for maternity confinements and
neonatal intensive care.
The Evolve Option provides cover for hospitalisation at the Evolve Network of private hospitals. There is no overall annual limit for hospitalisation.
Associated specialists are covered in full. Non-Associated specialists are covered up to 100% of the Momentum Health Rate.
A co-payment of R1 570 will apply per hospital authorisation, except in the case of motor vehicle accidents, maternity confinements and emergency treatment.
You can view a detailed breakdown of changes to all Momentum Health plans here.
- Offers 15 plans Across 3 scheme categories.
- Self-administered which means more of your money goes towards benefits and less towards administration;
- No self-payment gaps;
- Fewer co-payments – 75% fewer than competitors, the scheme claims;
For 2020, all limits and sub-limits have been increased by 5.2% across all options, and new benefits have been added to relevant plans.
For example, mammary surgery has been included as a benefit (up to R35,000) on Pace and Pulse 2 plans, while Diabetes Primary Care Consultations have been added to out-of-hospital benefits at 100% Scheme tariff.
For detailed changes to the schemes, you can view this document.
- Offers 11 plans Across 5 scheme categories;
- Full cover for 270 PMBs and 26 chronic conditions;
- No annual 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;
- Access to online wellness programmes and emergency app.
On top of the sizeable increase of 11.9% on schemes for the year, MediHelp members will see an average limit increase of 5.4% in 2020. One of the biggest changes will be seen in the Necesse band of plans, which has been collapsed to two bands, which will result in some members seeing their fees increase by 30%. Other changes vary across the different plans, including more maternity consultations for members on Prime 2 and additional hospitals being added to the Prime network.
A breakdown of changes can be read here.
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