The Council for Medical Schemes (CMS) has officially launched a forensic investigation into Bonitas, the nation’s second-largest open medical scheme. Bonitas faces investigation over allegations of improper procurement processes related to a key contract for its low-income option. The investigation will focus specifically on a contract awarded by Bonitas to Private Health Administrators (PHA) for the administration of its Boncap…
Tag: medical aid
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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)…
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Medical Tax Credits: A Change in Healthcare Policy
The financial reality of implementing South Africa’s National Health Insurance (NHI) is drawing nearer. The Department of Health confirms it is actively pursuing plans to phase out medical tax credits. This will help fund the ambitious scheme. The initial focus will be on high-income earners, marking the first concrete financial step towards overhauling the nation’s healthcare system. The department is…
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Private Healthcare: Addressing Funding Concerns in South Africa
Speakers at this year’s Hospital Association of South Africa (HASA) conference presented a stark reality to delegates: both public and private healthcare funding in the nation is heading towards a sustainability crisis. While potential solutions involving smarter collaboration and resource pooling exist, the path to implementation remains fraught with inaction. Political inertia is also a significant barrier. The conference unfolded…
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Medical Aid Tax Credits Impact on Private Healthcare
The Department of Health is actively collaborating with the National Treasury to establish thresholds for medical aid tax credits. This signals the first concrete steps towards phasing them out to fund the National Health Insurance (NHI) scheme. While officials insist the initial changes will only affect high-income earners, the move has ignited fierce criticism. It has raised concerns about transparency…
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Upfront Medical Aid Payments a Growing Concern
Upfront medical aid payments cost members of medical aid schemes a staggering R43 billion last year. This is a situation the industry regulator says is causing significant financial hardship and worsening health inequalities. The Council for Medical Schemes (CMS) revealed the figure in its 2023-24 industry report. It highlights a system where members are increasingly shouldering costs that they expect…
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Medical Aid Premiums to Continue Outpacing Inflation
Multiple sources are warning South African consumers to brace for continued high increases in their medical aid premiums. Experts expect costs to keep rising significantly faster than general inflation. The caution comes from Adrian Gore, CEO of Discovery, the country’s largest medical scheme administrator. He suggests that the underlying drivers of medical inflation continue to be a persistent challenge for…
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Billions Lost to Fraud and Waste Cripple SA’s Private Healthcare
South Africa’s private healthcare sector is haemorrhaging up to R28 billion a year due to rampant fraud, waste, and abuse (FWA). This directly threatens the quality of care and financial stability of medical cover for millions of citizens. The stark warning comes from the Health Funders Association (HFA), which estimates the losses represent a staggering 15% to 20% of all…
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Health Minister Moves to Halt NHI Legal Battles
Health Minister Aaron Motsoaledi has launched a legal manoeuvre aimed at pausing the multiple court challenges currently facing the contentious National Health Insurance (NHI) Act. In an application to the High Court, the Health Minister is seeking to consolidate all cases. He also wants to suspend proceedings until a separate but related legal battle involving President Cyril Ramaphosa’s decision to…
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Gems Premium Hike: Unions Demand Single Digits
South Africa’s largest medical scheme for public servants, Gems, is facing mounting pressure from unions. They want to limit its 2026 premium increase to single digits. This follows a controversial 13.4% hike this year. Following several years of modest increases, the double-digit rise for 2025 drew strong opposition from public sector unions. These include the Public Servants Association (PSA) and…
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Discovery Health’s Top Claims of 2024 Revealed
Discovery Health Medical Scheme (DHMS) has revealed the immense scale of its 2024 claims. It paid out a total of R83 billion last year. The scheme highlighted its ten highest individual claims, which alone amounted to R70.5 million. This underscores the critical role of medical cover in managing catastrophic health events. Presenting at the scheme’s Annual General Meeting (AGM), DHMS…
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Medical Schemes Face Legal Action Over Profiling
The Council for Medical Schemes (CMS) is considering legal action against major medical aid schemes and administrators in response to the report. It found evidence of racial profiling against Black healthcare providers. Medical schemes could be heavily impacted. The Council for Medical Schemes (CMS) has warned it may pursue legal action, potentially through the Equality Court, against some of South…