Which South African medical aid scheme is the best?

Which is the best medical aid scheme in South Africa? This is a question that we often find ourselves asking.

The internet is full of articles and each medical aid scheme will tell you that they are the best. Is there a “best” medical aid scheme in South Africa?

To tell you the truth: There isn’t one!

We have market leaders and schemes that come in at a close second but ultimately there isn’t a single medical aid that stands out above the rest.

The gist of it is that each medical scheme has their own attributes, but what it really boils down to is not which medical aid is the best, but rather which medical aid is best for you!

Amelia de Milander, Marketing & Communications Manager at Optivest Health Solutions recently stated that one cannot really put one medical scheme above another. “Even those medical schemes that are seen as the market leaders are not  necessarily the best.”

It all depends on your healthcare needs and available budget.

If you are still young and healthy, then you won’t need a comprehensive plan which would give you day-to-day benefits such as GP and dentist visits.

“For those who do have chronic medication needs and are older and perhaps not so healthy anymore, there are also different options and plans to choose from,” she says. “Medical schemes are expensive, so if you only want cover should you fall ill or injured and need hospital treatment, then you can save a lot by not going for an expensive option that offers full benefits.”

Comparative Medical Aid Quotes

If bigger isn’t always better, then the best way to determine which medical aid is the right one for you would be to get a comparative quotation, based on a focused needs analysis.

Such a comparative quote can be obtained by visiting Medical Aid Search at www.medicalaidsearch.co.za that allows you to get a range of medical aid quotes  with a few clicks of a button.

So, you’ve completed the needs analysis to get that quote, what now?

If knowledge is power, get ready to have the power placed directly in your hands! Below we will give you all the information you could possibly need to make an informed decision.

Here we expose the statistic of the beneficiary’s toll, growth ratio and solvency ratio of the top open medical aid schemes for the 2015 – 2016 financial period.

Disclaimer: Most scheme’s 2017 annual financial reports are currently not available. Therefore we have updated this post with the financial statements of 2015/2016. We will update the figures as soon as all medical aid scheme’s 2017 financial statements becomes available to us.

Best Medical Aid Scheme in South Africa According to Growth

Scheme Total Members (2016) Total Members (2015) Growth Ratio (2016)
Bestmed 94 941 94 266 0.72%
Bonitas 348 088 295 488 17.80%
Discovery 1 297 466 1 267 877 2.33%
Fedhealth 73 480 71 228 3.16%
Genesis 9 082 8 592 5.70%
Keyhealth 35 758 36 027 – 0.75%
Medihelp 90 585 91 947 – 1.48%
Medshield 73 390 75 006 – 2.15%
Momentum not available not available
Resolution Health 17 957 21 048 – 14.69%
Sizwe 50 001 52 317 – 4.43%
Spectramed not available not available
Topmed 22 355 25 665 – 12.90%

Bonitas showed the best increase in membership between the 2015 and 2016 financial year with a member growth of 17.80%.

On the other had, Resolution Health showed a decrease in membership with a loss of 14.69% in members. Topmed is second when losing members with a loss of 12.90% in members.

Why The Size of Your Medical Aid Scheme Doesn’t Matter

While a few of the medical aid schemes have shown a steady growth ratio, others have declined somewhat.

As mentioned before it is not necessarily the size of a medical scheme that matters, but rather scheme’s solvency ratio.

Best Medical Aid Scheme According To Solvency Ratio

Brian Watson, Executive at Genesis, states that “it is the solvency ratio and the ability of a medical scheme to settle its member’s medical bills that matter”.

In laymen terms, the higher a schemes solvency ratio, the better the odds are that your medical claims will be settled.

In The Council for Medical Schemes Circular 4 of 2013, the council stated “there is no proven benefit for members who belong to big medical schemes – in terms of lower costs as a result of economies of scale”.

What this means is bigger isn’t always better, just because a medical aid scheme has more members it doesn’t necessarily reflect their sustainability or their ability to pay claims.

The statutory requirement for a medical scheme’s solvency ratio is 25%, noted below is the solvency ratio for the 2015 – 2016 financial period for all South African medical schemes.

Scheme 2016 Solvency Ratio 2015 Solvency Ratio Solvency Growth
Bestmed 26.88% 25.58% 1.3%
Bonitas 24.4% 26.1% – 1.7%
Discovery 26.33% 25.98% 0.35%
Fedhealth 31.52% 35.65% – 4.13%
Genesis 173% 163% 10%
Keyhealth 31.0% 32.9% – 1.9%
Medihelp 28.74% 29.61% – 0.87%
Medshield 54.3% 55.6% – 0.9%
Momentum not available not available
Resolution Health 12.18% 10.45% 1.73%
Sizwe 52.05% 48.13% 3.92%
Spectramed not available not available
Topmed 77.87% 86.42% – 8.55%

As can seen above, even though Discovery Health is the biggest open medical aid scheme in South Africa, their solvency ratio is just above the minimum solvency ratio requirement.

On the other hand, Genesis has the lowest amount of members, but the highest solvency ratio (173%).

Another thing that can be seen is the reason for Resolution Health’s decline in membership. Having the lowest solvency ratio  of 12.18%. This might have led the scheme’s inability to settle its member’s medical aid claims and thus might be the reason behind the decline in membership.

Although Topmed has lost almost 13% of its members between 2015 and 2016, the scheme has a very healthy solvency ratio. Therefore, an inability to pay claims might not be the reason for the decline in members.

On the other hand, Bonitas has had the most increase in members (17.8%), but their solvency ratio is just below the statutory requirement.

Best Medical Aid According To Global Credit Rating

We have all seen medical aid global credit ratings. The ratings are usually presented as AA+ or BBB- but what is a global credit rating? Who does this credit rating and why is it done?

What Is a Global Credit Rating?

A global credit rating is a reflection of an evaluation of the organisation’s (in this case medical aid schemes) current financial standing, as well as the expected future standing.

Who Does The Credit Rating?

An organisations credit rating is undertaken by the GCR or Global Credit Rating Company. The Global Credit Rating Company focuses on the fundamentals of an organisation, analysing both the historical as well as current financial situation and how that can affect changes in the medium term.

Why Is a Credit Rating Done?

A credit rating analysis is used as a platform for developing expectations relating to the organisations future risk profile and financial performance in both a good and stressed economical climate.

Scheme Current Rating
Discovery AA+
Fedhealth AA-
Medihelp AA-
Medshield AA-
Momentum AA
Profmed AA
Resolution Health BBB-
Sizwe A+

The Best Medical Aid in South Africa

The statistics show that approximately 45% of all medical aids have shown a steady growth and that 81% have a solvency ratio above 25% (the statutory requirement). That coupled with a healthy Global Credit Rating, leads us to the logical conclusion that there isn’t a single “best” medical aid. Only one that is best for you!

“At Optivest Health Solutions we see it everyday – the only way to make an informed decision is to fully understand all the risks and benefits involved, says Amelia.

The best way to find a medical aid scheme that will suit your medical needs and your pocket is to visit Medical Aid Search at www.medicalaidsearch.co.za.

Even though there are quite a few questions that need to be answered when applying for a medical aid quote, you can rest assured that the ends justifies the means.

The more information the medical aid consultants receive, the better equipped they will be to identify the top medical schemes to suite your needs.

Keep in mind that all of the consultants are trained professionals, and are fully capable to answer any related queries you may have.

Optivest Health Solutions is the fulfilment partner and accredited financial service provider for Medical Aid Search.