As the year comes to a close, it’s time for the South African medical schemes to announce their annual contribution adjustments. Whether the increase is small or a little higher, it all boils down to several factors, including recommendations from governing bodies like The Council for Medical Schemes (CMS) and various other influences. Let’s dive into what’s driving the changes!
Who Decides How Much Medical Aid Contributions Go Up?
It all starts with the actuaries—those number-crunching wizards hired by medical schemes to predict next year’s costs. They calculate how much your plan will need to cover medical claims, admin fees, and other costs, then submit those figures to CMS for approval. The CMS reviews these increases to make sure they’re fair for all South Africans, keeping in mind the economy and any real-world challenges that might impact consumers.
What are “Reasonable Utilisation Estimates” for Medical Aid?
This fancy term simply refers to how much medical schemes predict their members will use in the coming year. These estimates are based on several factors, like:
- Member demographics (age, health status, etc.)
- Current and past claim trends
- Other key data
For example, if the scheme has a lot of younger, healthier members, the percentage increase might be on the smaller side since they’re less likely to make claims. On the other hand, schemes with an older member base tend to have higher increases because, as we know, more trips to the doctor become likely with age, bumping up the claims rate.
How Does a Medical Aid Determine the Price of a Product?
To decide how much your medical aid contribution should increase, the scheme starts with the basics—covering the prescribed minimum benefits required by law. But that’s not all! They also consider:
- Co-payments and benefit limits for big-ticket items like scans and surgeries, which help manage costs (but might mean a bit more out of your pocket).
- Non-healthcare costs like admin fees, advisor services, and even marketing costs, which also influence the final price.
The CMS monitors all these calculations to make sure that increases are necessary and balanced.
Why Do These Increases Matter?
Understanding why your employer-group medical aid plan is increasing is key. Without these annual adjustments, medical schemes would struggle to stay afloat—and you’d risk losing out on the benefits you rely on. Simply put, these increases are about keeping your cover sustainable and ensuring you get the care you need when you need it.
So far, here’s what some of the medical schemes have announced for 2025:
- Sizwe: 13.73%
- Discovery: 9.3%
- Momentum: 9.4%
- Medihelp: 10.8%
- Bonitas: 10.2%
- BestMed: 12.75%
- Umvuzo: 8.93%
While increases can feel like a pinch, they’re ultimately there to keep your health—and your peace of mind—well-protected.
Clarity Employee Benefits is an authorized Financial Services Provider – FSP No. 51007 please do not hesitate to reach out for medical aid guidance or advice.
