Top 10 Facts About Medical Aids in South Africa

1. South Africa has a population of around 51,8 million people. Only 8,5 million people, or roughly 16%, of the population,  belong to medical aid schemes. Therefore about 43,3 million people rely on the public health system for their medical needs.

2. There are 97 medical aid schemes in South Africa. Just 26 of these are open medical schemes, meaning that anyone can become a member. The other 71 medical aids are restricted schemes, meaning that only employees of certain companies or in certain industries may join them.

3. Open schemes cover about 4,7 million of all medical aid members while restricted schemes cover the rest of all medical scheme members, or about 3,7 million people.

4. According to the SA Council for Medical Schemes, the top ten medical aid schemes in South Africa, in terms of membership, are Discovery Health, GEMS, Bonitas, SAPS Medical Scheme, Medihelp, Medshield, Bankmed, Momentum Health, Sizwe Medical Fund and Fedhealth.

Top 10 Facts About Medical Aids

5. Of these, only three are restricted schemes, namely GEMS, which serves government employees; SAPS Medical scheme, which serves employees of the SA Police Service; and Bankmed, which serves employees in the banking industry.

6. The largest medical aid scheme in South Africa is Discovery Health, which has around 2,3 million members. The next is size is GEMS, a restricted fund, which has about 1,3 million members.

7. The five largest medical aid scheme administrators in South Africa are Discovery Health, Metropolitan Health Corporate, Medscheme Holdings, Momentum Medical Scheme Administrators and  V Med Administrators. Together these bodies administer 79,3% of the market.

8. Self-administered medical schemes (medical schemes that process claims and payments themselves) account for 10,2% of the market share.

9. The statutory body overseeing medical schemes is the Council for Medical Schemes.

10. For a full list of the all 97 medical schemes in South Africa, go here.