In a move that feels a bit like a “three-month payment holiday”, Discovery Health Medical Scheme (DHMS), the country’s largest open scheme, is deferring its 2026 contribution increases from 1 January to 1 April. This strategic deferral will save members R1.5 billion – about R1 100 per member – keeping costs at 2025 levels for the first three months of next year.
This initiative illustrates how medical schemes are increasingly adopting innovative approaches to balance affordability with sustainability, particularly as South Africans face mounting economic pressures. As the leading schemes announce their 2026 contributions, it is clear that affordability and innovation remain top of mind.
DHMS has announced a weighted average increase of 7.2%, Bonitas an average of 8.8% across its plans, Medihelp an 8.46% weighted average increase, and Bestmed a 6.8% weighted average increase.
Although any increase affects household budgets, the 2026 adjustments are generally lower than those in the past two years. For context, the 2025 increases were: Discovery 9.3%, Bonitas 10.2%, Medihelp 10.8%, and Bestmed 12.75%. Historical averages for 2024 were similarly elevated, highlighting the gradual easing in year-on-year contribution growth.
In Circular 24 of 2025, the Council for Medical Schemes (CMS) advised that contribution increases for 2026 should be capped at 3.3% “plus reasonable utilisation estimates”. This recommendation is stricter than last year’s 4.4% guidance and the 5% suggested two years ago, yet schemes continue to exceed these limits.
Read: Medical scheme hikes: CMS calls for restraint, but will schemes listen?
“The annual medical scheme contribution rates have consistently increased at a higher rate than consumer inflation. The CMS remains concerned by this trend, as it places a significant financial burden on members of medical schemes. Coupled with steep increases in the price of electricity and high food inflation, it is evident that most household budgets are significantly constrained,” the Circular states.
Contribution increases and benefit updates for 2026 have been submitted to the CMS for approval. Contribution increases will be effective from 1 January – except Discovery’s, which will be effective from April – while benefit updates and new benefit options will be effective from 1 January 2026, subject to CMS approval.
Discovery Health
DHMS has announced a 7.2% weighted average contribution increase for 2026, with 65% of members facing a 6.9% increase. Notably, contributions for members on Active Smart plans remain unchanged from 2025.
In addition to deferring contributions to 1 April 2026, the scheme is introducing two major enhancements:
- Smart Saver Series – plans tailored for young families, including Classic Smart Saver and Essential Smart Saver. “Smart Saver sets a new standard in affordable healthcare for families seeking meaningful cover at an accessible price,” says Dr Ron Whelan, the chief executive of Discovery Health.
- Enhanced Personal Health Fund Benefits – members accumulate funds through Personal Health Pathways by completing health actions, unlocking greater day-to-day healthcare value.
“This strategic use of excess solvency enables the scheme to offer members meaningful financial relief without compromising its long-term sustainability,” Whelan explains.
“Contribution increases remain accurately priced, in line with medical inflation, ensuring affordability and long-term stability. This approach reflects Discovery Health Medical Scheme’s commitment to using every lever available to enhance member value.”
The Active Smart plan will see a 0% increase, reinforcing affordability for young professionals.
“With more than 80% of new members under the age of 40, Active Smart’s design supports the scheme’s long-term sustainability… Members will continue paying R1 350 per month next year,” Whelan says.
Bonitas Medical Fund
Bonitas has announced a weighted average contribution increase of 8.8% for 2026. Certain “strategic options” will see lower-than-average increases aimed at improving accessibility.
“Every benefit adjustment in the 2026 range was guided by the data we see daily from our members’ health needs,” said Lee Callakoppen, the principal officer of Bonitas Medical Fund. “We looked at the current utilisation patterns of members and claims data and are confident that our offerings are aligned to the care our members need.”
In July 2024, the scheme resolved to reduce its solvency ratio by about 3% to 4% over two years, redirecting between R600 million and R700 million annually from reserves back to members. The aim was to support lower contribution increases, enhance benefits, and limit co-payments.
As of 31 December 2024, Bonitas’s solvency stood at 38.6%, a 2.9% decrease from the previous year but still well above the legislated minimum of 25%. Its reserves remained stable at R9 billion.
This financial position was supported by:
- Investment income delivering a 13.4% return, almost double the 7.7% achieved in the previous year.
- Value chain efficiencies, including hospital tariff management and managed-care initiatives, which generated savings of more than R1.4bn.
Bonitas noted that its financial strength enables it to absorb healthcare cost pressures and keep contributions as affordable as possible while maintaining access to quality care.
Over the past two years, the scheme has used its financial flexibility to:
- Expand the Benefit Booster, unlocking up to R600m in extra benefits since inception, with further increases on some plans in 2026.
- Contain co-payments while extending cover and benefit limits.
- Invest in preventative care, digital access, and mental health support to promote earlier interventions and reduce the burden of chronic conditions.
For 2026, Bonitas is also introducing two new options:
- BonCore: a digitally enabled hospital plan with limited GP consultations, unlimited hospital cover at a defined network, virtual-first primary care, preventative screening, and a R1 000 Benefit Booster. Priced at R1 275 per beneficiary, it is aimed at younger, cost-conscious professionals.
- BonPrime: a restructured version of the Primary Select option, now featuring a 16% medical savings account while retaining its existing hospital network.
Medihelp Medical Scheme
Medihelp’s average weighted contribution increase for 2026 is 8.46%, with the lowest increase across selected plans set at 6%.
Varsha Vala, the principal officer of Medihelp, said the scheme has focused on affordability through actuarial oversight, contribution strategies, cost containment, and member-focused product design.
She highlighted that in 2026, Medihelp plans to make it easier for members to access care through plan enhancements and simplified processes. Key additions include:
- Care extender benefit: Members who complete a combined health screening will receive R1 000 in over-the-counter medicine benefits per family per year, almost double the 2025 amount, and one additional GP visit.
- Preventive screening: Pap smears and prostate tests can now be requested by any qualifying healthcare professional, including registered nurses, without affecting members’ savings or day-to-day benefits.
Medihelp will also introduce a savings plan feature allowing members to adjust whether co-payments are paid from their medical savings account at any time during the year.
Vala said: “This elevates Medihelp from simply allocating savings to actively empowering members to manage and grow their benefits. It’s flexible, member-driven, and unique in the South African market.”
From 2026, only the highest procedure-specific co-payment per admission will apply, reducing members’ out-of-pocket costs.
Vala added the changes were intended to support members’ healthcare journeys while maintaining the scheme’s sustainability.
Bestmed Medical Scheme
Bestmed will implement an average weighted increase of 6.8%, with some options increasing by as little as 5.1%, demonstrating a focus on affordability.
“Healthcare inflation remains one of the biggest challenges facing households,” said Leo Dlamini, the chief executive and principal officer of Bestmed. “But our responsibility is clear: to safeguard the depth of our benefits, while ensuring contributions remain competitive. That’s why for 2026, we’re not only protecting our current benefits, but we’re adding important new preventative care benefits as well.”
New benefits include colon cancer and HIV screening, expanded PSA screening, and an additional IUD benefit. Other enhancements cover higher limits on cochlear implants, shoulder prostheses, adenoidectomy, take-home medicine, and expanded breast reduction surgery coverage.
“Our expanded benefits reflect the changing needs of our members, from oncology to women’s health, while continuing to reinforce our commitment to delivering tangible value and improved quality of care,” Dlamini added.
Balancing act – affordability and accessibility
Although the 2026 increases reflect careful balancing acts, medical schemes are operating under intense pressures. The CMS has highlighted that contribution hikes above inflation are increasingly unaffordable for households grappling with high living costs.
Globally, the International Monetary Fund expects economic growth to slow from 3.3% in 2024 to 2.8% in 2025, while South Africa’s growth is projected at just 1% in 2025 and 1.3% in 2026, far too low to ease unemployment, which is already 33.2%. Against this backdrop, the CMS is urging schemes to “tighten the reins”, carefully managing contribution increases relative to headline inflation, healthcare utilisation trends, medicine pricing, and reserves.
“Although private medical inflation generally exceeds CPI by 2% to 3%, CMS believes that the annual industry price increase assumptions should be linked to inflation. With cash-strapped consumers grappling with the current cost-of-living crisis, raising contributions above CPI is simply unaffordable for most households,” the regulator notes.
Rising healthcare utilisation remains a key pressure point, while hospital and specialist costs continue to dominate spending. Schemes must balance maintaining strong reserves with offering meaningful relief from medical inflation.
The CMS cautions against under-pricing that could erode reserves, warning that “there will be severe consequences for such conduct, including barring such individuals from rendering services to medical schemes and reporting such individuals to the Actuarial Society”.
In this context, the 2026 contribution increases highlight the delicate act of maintaining both affordability and access to essential healthcare. Innovation, solvency management, and preventative care are central to this balance – ensuring South African households can continue to access meaningful medical cover without compromising quality or sustainability.
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