South Africa: leading medical schemes 2021

In 2021, Discovery Health placed first out of the 20 leading medical health schemes in South Africa, with approximately 2.8 million beneficiaries. The Government Employees Medical Scheme (GEMS) ranked second with around 1.9 million private healthcare recipients. Discovery Health is an open medical scheme which is available to all South Africans who can pay for membership, whereas GEMS is a restricted scheme reserved for governmental employees.

Medical scheme beneficiaries in South Africa

  In 2022, the share of medical aid beneficiaries in South Africa was around 15.8 percent, which represents approximately 9.7 million of the country’s total population of 61 million. Although the Black African population group had the highest number of medical beneficiaries with medical aid coverage, they also had a significantly high amount without coverage.

Medical scheme plans in South Africa

Medical schemes in South Africa have various plans which range from covering essential medical care to extensive medical care. Plans offered by Discovery Health, the leading open medical scheme, varied in 2023 with the cheapest being KeyCare and the most expensive being Executive. Furthermore, the most affordable plan offered by GEMS, the largest restricted scheme in the country, is the Tanzanite One. On the other hand, the Onyx option was the priciest although it has higher benefits.

Leading medical schemes in South Africa in 2021, by number of beneficiaries (in millions)

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Release date

October 2022

More information

Region

South Africa

Survey time period

2021

Supplementary notes

* GEMS stands for the Government Employees Medical Scheme.

* POLMED stands for the South African Police Service Medical Scheme.

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.

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.

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