Medihelp Medical Scheme has announced its contribution adjustments for 2026, with increases carefully balanced to protect affordability while ensuring long-term sustainability. The lowest increase across selected plans is 6%, while the scheme’s average weighted increase is 8.46%.
“While contribution increases remain an industry reality, Medihelp has prioritised affordability through disciplined actuarial oversight, prudent contribution strategies, cost containment, and member-focused product design,” said Varsha Vala (pictured), the principal officer of Medihelp. “These measures are about ensuring protection, financial resilience, and peace of mind for our members and employer partners.”
Financial sustainability
While Medihelp’s solvency ratio is currently marginally below the statutory requirement of 25%, the scheme remains on track to reach this threshold by the end of 2025.
“The temporary dip reflects a conscious decision made during Covid-19, when Medihelp froze increases and even reduced average contributions to ease the financial strain many of our members were experiencing at the time,” Vala explained.
Enhancing value and care in 2026
In 2026, Medihelp will make it even easier for members to access care through smart plan enhancements, simplified processes, and new benefits designed with members in mind.
Key additions include:
- Boosted care extender benefit: Members who complete a combo health screening will unlock R1 000 (almost double the 2025 amount) in over-the-counter medicine benefits per family per year, plus 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.
At Medihelp, prevention doesn’t just save lives – it saves rands, right here and now.
Industry-first member flexibility
Medihelp is introducing a first-of-its-kind savings plan feature. From 2026, members will be able to adjust their medical savings preference (whether or not co-payments are paid from their savings account) at any point during the year.
“This elevates Medihelp from simply allocating savings to actively empowering members to manage and grow their benefits,” Vala explained. “It’s flexible, member-driven, and unique in the South African market.”
Best-in-class managed care
“Our managed care capability is among the best in the country,” Vala noted. “By applying data and AI, we’ve evolved from predictive care management that identifies risks, to prescriptive care that enables us to recommend specific actions to prevent complications and improve outcomes.”
An example is Medihelp’s post-hospitalisation care programme, which provides up to 30 days of follow-up consultations and services after high-risk procedures, guided by a dedicated care co-ordinator.
“This proactive approach reduces complications, prevents unnecessary costs later, and provides employers and members significant hours back,” added Vala.
“We don’t just analyse data; we act on it – delivering better health for members and smarter pricing for the future.”
Simplified co-payments
From 2026, only the highest procedure-specific co-payment per admission will apply, streamlining members’ out-of-pocket costs.
Convenience and peace of mind
Members on chronic medication can now choose to have their medicine delivered to their home or workplace.
“This is a significant service upgrade that enhances trust and convenience, especially for members managing chronic conditions. It also addresses potential safety concerns and ensures proper cold-chain compliance for sensitive medicines,” said Vala.
Product innovation: MedReach
Launched in 2025, MedReach – a plan designed for ambitious professionals – continues to grow in popularity. It balances affordability with comprehensive cover, affirming Medihelp’s positioning: “We’ve got a plan for everybody.”
Well-being rewards with Omnihelp
Through Medihelp’s collaboration with Omnihelp, members gain access to a holistic rewards programme that rivals the best in the industry. Unlike traditional rewards programmes that focus mainly on physical and financial aspects, Omnihelp recognises all pillars of health by guiding and rewarding mental, emotional, lifestyle, and physical well-being.
“Medihelp is committed not only to supporting physical health but also to every dimension of well-being through Omnihelp,” said Vala. “We’re dedicated to helping our members live healthier, fuller lives.”
Dedicated value for employer groups
Employer partners benefit from:
- health kiosks at wellness days;
- post-event wellness insights;
- a Parenting Journey programme;
- seamless online bookings and virtual consultations; and
- a dedicated digital platform to manage corporate medical scheme business.
Commitment to members
“Overall, these changes are carefully designed to support our members’ healthcare journeys while keeping sustainability front and centre,” said Vala.
“Medihelp’s focus remains on delivering meaningful value, pioneering solutions, and ensuring that our members and employer partners experience healthcare cover they can trust.
“Ultimately, providing cover when members are unwell isn’t our only role – we are a healthcare partner, committed to the overall well-being of all our members who trust us,” concluded Vala.
