Medical scheme contributions for 2027 have become a point of contention between the Board of Healthcare Funders (BHF) and the Council for Medical Schemes (CMS). The BHF has challenged the regulator’s guidance that schemes anchor next year’s contribution increases at 3.8%. It argues that the figure does not adequately reflect the cost pressures facing the industry. The association represents schemes…
Tag: healthcare costs
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Gap Cover Gains Importance as Costs Rise
Medical aid remains central to accessing private healthcare in South Africa, but members can no longer assume it will cover the full cost of treatment. In 2026, increases in medical scheme contributions have continued to put household budgets under pressure. Healthcare cost inflation is also running well above consumer inflation, while many scheme options have introduced more co-payments, sub-limits and…
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Medical Scheme Financial Pressure Escalates As Costs Soar
South Africa’s private healthcare sector is facing a severe sustainability crisis. According to a new report by Alexander Forbes Health, the medical scheme industry is trapped in a tightening financial vice. Rising provider fees, escalating utilisation, and rapid technological advances are driving up the cost of care across the board. Paresh Prema, the head of technical and actuarial consulting at…
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Excessive Dialysis Product Pricing: Adcock Ingram Referred
South Africa’s Competition Commission has referred pharmaceutical manufacturer Adcock Ingram’s hospital division to the Competition Tribunal for prosecution over alleged excessive pricing of kidney dialysis products. The referral, announced on 3 June 2026, targets Adcock Ingram Critical Care (AICC) and covers pricing for peritoneal dialysis and continuous renal replacement therapy (CRRT) products between July 2019 and June 2024. The commission…
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Employer-Sponsored Health Insurance Costs Rising Sharply
A salaried job with health benefits has long been the gold standard of US employment. That assumption is now under serious pressure. Sharply rising premiums are prompting young, healthy workers to opt out of company health plans. Some are going without cover entirely. Others are turning to cheaper alternatives such as medical cost-sharing cooperatives. The trend is a growing concern…
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Bonitas Medscheme Split Sees Momentum and PHA Win Contracts
The Bonitas Medscheme Split has become a major topic in the South African healthcare sector. Bonitas Medical Fund, South Africa’s second-largest open medical scheme, has confirmed a major supplier shake-up. It will end its long-running administration relationship with Medscheme and hand key roles to Momentum Health and Private Health Administrators (PHA). The changes cover all Bonitas options except Boncap, its…
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GEMS Tariff Intervention Underway Amid Affordability Concerns
The South African government has stepped into the controversy surrounding sharp increases in contributions to the Government Employees Medical Scheme (GEMS). Public Service and Administration Minister Mzamo Buthelezi told Parliament that officials will engage with GEMS trustees regarding what he called “unaffordable tariffs.” This follows a 9.8% hike in GEMS member contributions this year, on top of a 13.4% increase…
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‘Mega Gap Claims’ Explode by 512% as Medical Aid Shortfalls Soar
South African medical scheme members are facing an unprecedented financial crisis, as new data reveals that “mega” out-of-pocket gap claims have exploded by 512% in just four years. This alarming trend highlights the soaring medical aid shortfalls patients are forced to pay, driven by specialists charging up to 500% of scheme rates and medical aids systematically reducing benefits. The data,…
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Medical Aid Contribution Increases Squeeze Household Budgets
South African households are bracing for another year of financial pressure as major medical schemes begin announcing their contribution increases and benefit changes for 2026. In a familiar and unwelcome trend, the announced premium hikes are set to outpace the country’s general inflation rate significantly. This will deepen the long-standing healthcare affordability crisis. While the Council for Medical Schemes (CMS)…