Number of medical schemes in South Africa 2011-2021, by type

* Open medical schemes are open to all South Africans who are able to pay for membership.

* Restricted medical schemes are only available to people who work in specific industries, have certain academic qualifications, are employees of a certain company or belong to certain professional associations in South Africa.

The source states that even though the reported figure is 75 medical schemes in total, the council for medical schemes also pointed out that Hosmed Medical Scheme joined together with the Sizwe Medical Fund, and Quantum Medical Aid Society merged with Discovery Health Medical Scheme, which brings the total number of medical schemes to 73 as of December 2021.

South African medical schemes are non-profit trusts that their members own. The contributions made by the members are put together and used to pay pertinent medical costs where necessary while keeping a legislated surplus (at least a 25 percent solvency ratio) to prevent the scheme from collapsing. Some medical plans have an option for saving, which creates a collective savings from a member’s monthly payments for personal use.

Medical aid schemes are required by law to cover a set list of chronic illnesses, namely the Prescribed Minimum Benefits (PMB).This safeguards all medical scheme members so that they have access to the minimum amount of health services, regardless of which benefit option they have chosen. Furthermore, medical schemes are allowed to have different product plans, which often target specific demographics. For example: specialized benefits, annual limits, day-to-day coverage, family cover, and networked doctors and hospitals all differ across the various plans, both internally and from company to company.