largest medical schemes in south africaSouth Africa’s Council for Medical Schemes (CMS) has released its annual state of the industry report.

The 2021 report is of particular interest, since it covers the ongoing aftermath of the COVID-19 pandemic. The report details numbers of insured South Africans, across all registered medical aid schemes.

As a result of the pandemic, this number reduced from 8.99 million in 2019 to 8.89 million South Africans in 2020.

Of all covered members, there were 422,894 who were infected with Covid and made claims. 383,585 of them recovered.

Overall, the country has 76 registered medical schemes. That’s 2 fewer than the previous year, but that’s as a result of 2 mergers.

In late 2019, Topmed Medical Scheme amalgamated merged with Fedhealth Medical Scheme, while Selfmed Medical Scheme amalgamated merged with Compcare Wellness Medical Scheme.

Read: Does South Africa Medical Aid Cover Pre-existing Conditions?


The largest medical aid schemes in South Africa

As expected, Discovery Health Medical Scheme is still the largest by far. It boasts of over 1.3 million members and over 2.7 million beneficiaries. Coming second is the Government Employees Medical Scheme (GEMS), which boasts of over 750,000 members and close to 2 million beneficiaries.

Bonitas is third with 333,000 members; South African Police Service Medical Scheme (POLMED) comes fourth with 174,000 members; while Momentum Medical Scheme completes the top 5 with 152,000 members.

Other than Bankmed with 106,000 members, no other scheme has over 100,000 members.

These are the 15 biggest medical schemes in the country, which collectively hold almost half of all medical scheme memberships in the country.

Scheme Type 2020 Members 2020 Beneficiaries
Discovery Health Medical Scheme Open 1 330 513 2 758 340
Government Employees Medical Scheme (GEMS) Restricted 750 935 1 963 758
Bonitas Medical Fund Open 333 141 710 157
South African Police Service Medical Scheme (POLMED) Restricted 174 447 502 631
Momentum Medical Scheme Open 152 228 293 457
LA-Health Medical Scheme Restricted 89 041 222 882
Bankmed Restricted 106 467 218 930
Bestmed Medical Scheme Open 97 335 204 399
Medihelp Open 89 056 194 941
Medshield Medical Scheme Open 75 285 150 975
Fedhealth Medical Scheme Open 74 494 143 970
Sizwe Medical Fund Open 48 213 115 156
Platinum Health Restricted 52 062 92 255
Sasolmed Restricted 28 953 77 002
SAMWUMed Restricted 34 403 75 342

Compared to 2019, Discovery Health registered the largest decline in member numbers, losing close to 50,000 members.

These are the schemes that lost members.

Scheme 2019 Beneficiaries 2020 Beneficiaries Change
Discovery Health Medical Scheme 2 808 106 2 758 340 -49 766
Fedhealth Medical Scheme 156 904 143 970 -12 934
Bonitas Medical Fund 722 943 710 157 -12 786
Medihelp 204 305 194 941 -9 364
Thebemed 29 040 20 750 -8 290
Medshield Medical Scheme 158 996 150 975 -8 021
Momentum Medical Scheme 298 852 293 457 -5 395
South African Police Service Medical Scheme (POLMED) 507 764 502 631 -5 133
Transmed Medical Fund 34 703 30 211 -4 492
Motohealth Care 41 615 37 140 -4 475

On the opposite side of the spectrum, the Government Employees Medical Scheme (GEMS) saw a huge gain, adding over 71,000 new members in 2020.

These are the schemes that gained members.

Scheme 2019 Beneficiaries 2020 Beneficiaries Change
Government Employees Medical Scheme (GEMS) 1 892 295 1 963 758 +71 463
LA-Health Medical Scheme 208 258 222 882 +14 624
Bestmed Medical Scheme 199 297 204 399 +5 102
Sizwe Medical Fund 111 409 115 156 +3 747
Platinum Health 88 724 92 255 +3 531
Profmed 72 850 74 822 +1 972
SAMWUMed 73 570 75 342 +1 772
Makoti Medical Scheme 7 746 9 300 +1 554
Keyhealth 67 476 68 702 +1 226
Building & Construction Industry Medical Aid Fund 11 092 11 727 +635

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