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.

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.

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