This is how many people left South Africa’s biggest medical aid schemes in the last year

The Council for Medical Schemes (CMS) has published its annual industry report, showing how South Africa’s registered medical schemes navigated the Covid-19 pandemic in 2020, and how they fared in terms of membership.

According to the CMS, the overall medical aid industry saw Covid-19 claims to the value of R10.1 billion in 2020. There were 422,894 members of medical schemes infected with Covid-19 in 2020, and out of that number, 383,585 recoveries, representing a mortality rate of 3.02%.

These numbers are based on data from 73 schemes, representing 99.84% of medical scheme beneficiaries, it said.

South Africa now has 76 registered medical schemes, two fewer than in 2019 as a result of two mergers. Topmed Medical Scheme amalgamated with Fedhealth Medical Scheme on 1 August 2019, and Selfmed Medical Scheme amalgamated with Compcare Wellness Medical Scheme on 1 September 2019.

These 76 schemes had a total subscription of 8.89 million beneficiaries in 2020, down from 8.99 million in 2019 – a year-on-year decrease of 1.15%.

The number of beneficiaries covered by restricted schemes grew by 45,525 beneficiaries, and the number of beneficiaries covered by open schemes declined by 148,752 beneficiaries between 2019 and 2020 – a net loss of 103,227 beneficiaries across all schemes.

Biggest winners and losers

Discovery remains the largest medical scheme in the country, with 1.33 million members and 2.76 million beneficiaries. This is followed by the Government Employees Medical Scheme (GEMS) with 750,000 members and over 1.96 million beneficiaries.

The table below outlines the 15 biggest open and restricted schemes.

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

Discovery Health, which accounts for the lion’s share of the open scheme market, registered a loss of nearly 50,000 beneficiaries (-49,770 beneficiaries), followed by Fedhealth and Bonitas.

“Covid-19 undoubtedly negatively impacted the exposure data, with many individuals being laid off or losing their jobs, resulting in many members being unable to afford private health care,” the CMS said.

Being the largest medical scheme, Discovery’s larger loss of beneficiaries makes sense – however, it only represents a 1.8% decline in the overall number. A smaller medical scheme, like Thebemed, by comparison, suffered a larger loss, relative to its total beneficiaries (-28.5%).

The tables below outline the 10 medical schemes which saw the biggest drop in beneficiaries in 2020, and the 10 schemes which saw the biggest increase.

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
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

Read: Discovery vs Bonitas vs Momentum – how medical aid prices have increased in South Africa

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