|Organisation Name||Organisation Activate Date||Organisation Expiry||Contact||Address||Telephone||Web Address||Conditions|
|3SIXTY HEALTH (PTY) LTD (ADMIN: 8)||Jun 06, 2020||Jun 06, 2022||Dr N Mabuya||PO BOX 10436 JOHANNESBURG 2000||011 353 0025||https://www.3Sixtyhealth.co.za||View conditions|
|AFROCENTRIC INTEGRATED HEALTH ADMINISTRATORS (PTY) LTD (ADMIN: 10)||Feb 14, 2021||Feb 14, 2023||Mr C Marais||Postnet Suite #226, Private Bag X5 STRUBENSVALLEY 1735||011 758 8748||View conditions|
|AGILITY HEALTH (PTY) LTD (ADMIN: 3)||Jun 04, 2020||Jun 04, 2022||TP Masobe||PO BOX 7687 CENTURION 0046||012 673 5499||https://www.agilityghs.com||View conditions|
|BESTMED MEDICAL SCHEME (ADMIN: 62)||Dec 06, 2021||Dec 06, 2024||Leo Banele Dlamini||PO Box 2297 PRETORIA 0001||012 472 6000||https://www.bestmed.co.za||View conditions|
|CAPE MEDICAL PLAN MEDICAL SCHEME (ADMIN: 50)||Jun 30, 2021||Jun 30, 2024||Charlene Schoeman||PO BOX 966 PAROW 7499||0219378300||https://www.cmp.co.za||View conditions|
|CHARTERED ACCOUNTANTS (SA) MEDICAL AID FUND (ADMIN: 75)||Oct 23, 2021||Oct 23, 2024||MsM Olivier||PO Box 2964 RANDBURG 2125||011 707 8400||https://www.camaf.co.za||View conditions|
|DE BEERS BENEFIT SOCIETY (ADMIN: 57)||Dec 09, 2019||Dec 09, 2022||Mr MS Mathonzi||PO Box 1922 KIMBERLEY 8300||0538073111||https://www.dbbs.co.za||View conditions|
|DISCOVERY ADMINISTRATION SERVICES (PTY) LTD (ADMIN: 45)||Aug 27, 2020||Aug 27, 2022||Stephen Johnston||PO Box 786722 SANDTON 2146||011 529 1680||https://www.discovery.co.za||View conditions|
|DISCOVERY HEALTH (PTY) LTD (ADMIN: 19)||Dec 31, 2021||Dec 31, 2023||Dr RN Noach||PO BOX 786722 SANDTON 2146||011 529 3954||https://www.discovery.co.za||View conditions|
|FOODMED MEDICAL SCHEME (ADMIN: 63)||Jul 27, 2019||Jun 27, 2022||Dr N Behardien||PO Box 1067 PAROW 7499||(021) 930 3550||https://www.foodmed.co.za||View conditions|
|GENESIS MEDICAL SCHEME (ADMIN: 79)||Aug 13, 2021||Aug 13, 2024||D van der Merwe||PO BOX 144 OBSERVATORY 7925||021 4429900||https://www.genesismedical.co.za||View conditions|
|MEDIHELP MEDICAL SCHEME (ADMIN: 49)||Nov 13, 2021||Nov 13, 2024||da Silva E||PO BOX 26004 ARCADIA 0007||0860100678||https://www.medihelp.co.za||View conditions|
|MEDSCHEME HOLDINGS (PTY) LTD (ADMIN: 21)||Dec 31, 2021||Dec 31, 2023||Mr Johan van Rooyen||PO Box 1101 FLORIDA GLEN 1708||011 671 2000||https://www.medscheme.co.za||View conditions|
|MEDSHIELD MEDICAL SCHEME (ADMIN: 77)||Aug 27, 2020||Aug 27, 2023||MrThoneshan Naidoo||PO Box 4346 Randburg 2125||https://www.medshield.co.za||View conditions|
|METROPOLITAN HEALTH CORPORATE (PTY) LTD (ADMIN: 17)||Jan 01, 2022||Jan 01, 2024||Abdul Kader Mia Hamdulalay||PO BOX 2212 BELLVILLE 7535||021 480 5272||https://www.mhg.co.za||View conditions|
|MOMENTUM HEALTH SOLUTIONS (PTY) LTD (ADMIN: 13)||Jan 25, 2021||Jan 25, 2023||Johannes Hendrik Viljoen||PO Box 2338 DURBAN 4000||031 573 4000||https://www.momentummetropolitan.co.za||View conditions|
|MOMENTUM THEBE YA BOPHELO (PTY) LTD (ADMIN: 22)||Apr 07, 2020||Apr 07, 2022||Mangaliso Mahlaba||PO BOX 1672 PORT ELIZABETH 6000||011 544 8000||https://www.mementumtyb.co.za||View conditions|
|NATIONAL HEALTH GROUP (PTY) LTD (ADMIN: 72)||Oct 23, 2020||Oct 23, 2022||Mr P J Lubbe||PO Box 44331 CLAREMONT 7736||021 276 5603||https://www.nationalhealthcare.co.za||View conditions|
|PLATINUM HEALTH MEDICAL SCHEME (ADMIN: 53)||Dec 10, 2021||Dec 10, 2024||WELCOME MBONISO||PRIVATE BAG X82081 RUSTENBURG 0291||(087)463-0660||http://www.platinumhealth.co.za||View conditions|
|PRIVATE HEALTH ADMINISTRATORS (PTY) LTD (ADMIN: 11)||Jun 04, 2020||Jun 04, 2022||Mr C Marais||PO BOX 343 WESTVILLE 3630||(011)671-4844||https://www.pha.co.za||View conditions|
|PROFESSIONAL PROVIDENT SOCIETY HEALTHCARE ADMINISTRATORS (PTY) LTD (ADMIN: 37)||Jun 06, 2021||Jun 06, 2023||Mrs S Bassudev||Private Bag X1031 LYTTELTON 0140||(012)6794499||https://www.ppsha.co.za||View conditions|
|RAND WATER MEDICAL SCHEME (ADMIN: 56)||Oct 29, 2019||Oct 29, 2022||Mrs M NYEMBE||PO Box 1127 Johannesburg 2000||011 682 0985||https://www.randwater.co.za||View conditions|
|SAMWUMED (ADMIN: 55)||Aug 20, 2019||Aug 20, 2022||Mr C Marais||PO Box 134 Athlone 7760||021 697 9500||https://www.samwumed.org||View conditions|
|SEDMED (ADMIN: 65)||Dec 05, 2019||Dec 05, 2022||Mr A du Preez||PO Box 468 BLOEMFONTEIN 9300||(051)447-8991||View conditions|
|UMVUZO HEALTH MEDICAL SCHEME (ADMIN: 51)||Dec 10, 2021||Dec 10, 2024||HB van Zyl||PO BOX 1463 FAERIE GLEN 0043||0128450000||https://www.umvuzohealth.co.za||View conditions|
|UNIVERSAL HEALTHCARE ADMINISTRATORS (PTY) LTD (ADMIN: 5)||Jun 05, 2020||Jun 05, 2022||Mr M Russell Bayley||PO BOX 1411 RIVONIA 2128||011 208 9620||https://www.universal.co.za||View conditions|
|WITBANK COALFIELDS MEDICAL AID SCHEME (ADMIN: 54)||May 19, 2019||May 19, 2022||Ms Angela M Jacobs||PO Box 26 WITBANK 1035||013 6561407||View conditions|
Schemes administered by DRC (Dental Risk Company)
Necesse (Network Providers)
Discovery Administered Clients
Discovery Health KeyCare Plus Option
Discovery Health Start Option
LA Health KeyCare Option
Quantum Health KeyCare Option
Discovery TFG Health
Discovery Flexicare (FlexCare and FlexiCare Plus Options)
Remedi Standard Option
Bankmed Basic Option
Discovery LA Health Focus
Anglo Med (Standard Core Plan)
Moto Health Care
ProPinnacle Savvy Option
ProSecure Plus Option
ProSecure Plus Savvy Option
ProSecure Savvy Option
ProActive Savvy Option
ProActive Plus Option
ProActive Plus Savvy Option
Optima Establish Option
Optima Enhance Option
Value Core Plus Option
Day To Day Option
Affinity Health Dental Plan
Platinum Plus Option
Plan B Option
Plan B Plus Option
Plan C Option
Plan B Top-Up
Plan B Plus Top-Up
Plan C Top-Up
Balance Plus Option
Boost Plus Option
Day to Day Option
55 Plus 4 U Option
National Health Care
Option B Plus
Bonitas warns of increase in hospital costs
Hospital admissions are one of the most significant cost drivers for any private medical scheme, which is why the tariffs are often reviewed and negotiated annually. If no agreement is reached, medical aid members will typically bear the brunt of high co-payments.
Lee Callakoppen, principal officer of Bonitas Medical Fund, says that hospital admissions account for half of the scheme’s annual claims cost.
“Last year, due to the pandemic, hospital admissions and the utilisation of other medical aid benefits fell to record lows. However, the 2021 claims’ experience has shown that a lot of services, particularly the day-to-day benefits and several hospital admission categories, are already close to 2019 levels.”
Callakoppen warned that if hospital costs balloon above CPI, so will membership premiums, which will result in medical aid becoming unaffordable.
“We are appealing to all our service providers, including hospital groups, not to pass their costs on to schemes and, by extension, to members,” he said.
Moving into 2022
Callakoppen said that there are significant concerns about 2022 utilisation levels, notably due to the risk of an increased burden of disease due to gaps in care that may have arisen during the pandemic, which is no fault of any party.
He also anticipates an elective procedure claims catch-up after so many were cancelled in 2020 and 2021 during national lockdowns.
Other areas of concern include the unknown impact of long-haul Covid and new or more expensive Covid-19 treatment costs, including booster vaccines, which could emerge.
“All stakeholders in the healthcare value chain need to be prudent in managing their costs of doing business. The intention of negotiated hospital tariffs is to reach an agreement that supports sustainability of the healthcare ecosystem and, ultimately, members,” he said.
“The issue comes when there is no agreement reached, and members may have to pay in the difference between what the hospitals charge versus what the scheme is able to pay. We try to avoid such a situation so as not to have a negative member impact, but if parties are unreasonable in their demands, this situation may arise.”
What happens if negotiations fail?
However, when the costs of doing business are passed on to schemes and, by extension, customers – or medical aid members – things become complicated, especially where tariff increases agreements cannot be reached, said Callakoppen.
He said that in these instances, there are two possible scenarios:
- A scheme pays what it deems to be a reasonable rate, and the hospital bills its rate. This means the member would be required to pay in the shortfall on the account unless the hospital decides to override the difference.
- A scheme excludes the hospital from its network and actively discourages a member from using this hospital. The member may need to pay a deductible or co-payment if they choose to be admitted at this facility unless the hospital decides to override the difference.
“Neither of these situations is a favourable outcome,’ says Callakoppen. ‘Which is why reaching a workable middle ground on hospital cost/tariffs is imperative,” he said.
South Africa’s second-largest open medical aid scheme, Bonitas, has announced a weighted average increase of 4.8% for its medical plans in 2022.
Increases will vary across the group’s packages, with the BonStart premium contribution fee decreasing by 7.9%. This can be attributed to the low cost versus benefits ratio and the younger membership profile on the plan, Bonitas said.
The scheme has 338,751 principal members and 722,943 total beneficiaries.
The group said it will offer a total of 15 plans for 2022, comprising traditional, savings, hospital, edge (virtual), network and income-based plans, each appealing to different target markets.
Price changes range from minus -7.9% to +6.5%. Bonitas said it opted to increase its options which are currently in a growth phase – BonSave, BonFit and BonEssential – by only 3.6%.
The average increase of 4.8% is close to the recommendation from the Council for Medical Schemes (CMS), which recommended medical aid increases be in line with CPI of 4.2%.
Bonitas said that its average – a little over that value – is based on the CMS’ caveat that financial stability and sustainability of schemes remain a priority. The group is using R600 million of its reserves to keep price increases down.
New offerings being introduced include an additional virtual plan, BonStart Plus; a renewed focus on Managed Care with an oncology management programme; as well as an enhanced member app, powered by AMP, which includes a personalised wellness programme to encourage healthier behaviour, the group said.
This is how contributions will change for 2022:
|Plan||2021 price (principal)||2022 price (principal)||Change|
|BonComprehensive||R7 715||R8 217||+6.5%|
|BonClassic||R5 330||R5 677||+6.5%|
|BonComplete||R4 291||R4 570||+6.5%|
|BonSave||R2 847||R2 950||+3.6%|
|BonFit Select||R2 152||R2 230||+3.6%|
|BonStart||R1 452||R1 338||-7.9%|
|BonStart Plus (New)||–||R1 670||–|
|Standard||R4 044||R4 230||+4.6%|
|Standard Select||R3 859||R3 822||+6.5%|
|Primary||R2 537||R2 654||+4.6%|
|Primary Select||R2 180||R2 322||+6.5%|
|Hospital Standard||R2 434||R2 592||+6.5%|
|BonEssential||R1 962||R2 033||+3.6%|
|BonEssential Select||R1 675||R1 784||+6.5%|
|BonCap R0-R700 (New)||–||R780||–|
|BonCap R701-R9,430 (Revised)||R1 212||R1 274||+5.1%|
|BonCap R9,431-R15,320 (Revised)||R1 434||R1 507||+5.1%|
|BonCap R15,321-R19,930 (Revised)||R2 311||R2 429||+5.1%|
|BonCap R19,931+||R2 837||R2 982||+5.1%|
Please note the following products have had a NAME change.
Nappi codes and pricing remain unchanged:
|NAPPI CODE||OLD NAME||NEW NAME|
|714981001||TEEVIR (NAMIBIA)||TENOFOVIR DISO/FUMARATE/EFAV/EMTRIC|
|3000508001||AVALIFE FEMIFLORA (NAMIBIA)||AVALIFE AVAFEM (NAMIBIA)|
|3001116001||AVALIFE PROREUTERI-D (NAMIBIA)||AVALIFE AVATERI-D (NAMIBIA)|
|825212006||A-LENNON DIAZEPAM 10MG/2ML INJ||DIAZEPAM PHARMC|