Medscheme will take over the administration and managed care of Sisonke Health Medical Scheme from 1 May 2026, following a competitive tender process in which the administrator was selected across all categories.
According to a media statement released earlier this week, implementation planning is under way, with both parties working towards a transition that aims to ensure continuity of healthcare services for members.
The appointment follows a period of structural change at Sisonke, including its amalgamation with Lonmin Medical Scheme – a process that has reshaped the scheme’s scale, governance, and operational footprint.
Sisonke provides healthcare cover to employees of major mining groups, including Sibanye-Stillwater, Gold Fields, and DRD Gold, representing about 30 000 principal members and beneficiaries across Rustenburg, West Wits, and Welkom.
The scheme also owns and partners in a network of primary healthcare clinics in key mining regions.
Medscheme chief executive Andrew Schwulst said the appointment reflects both the scale and importance of the scheme.
“The scheme serves employees in one of South Africa’s most important industries, and we are committed to supporting it with clinically driven, digitally enabled, and operationally strong solutions that improve healthcare outcomes for members.”
Acting principal officer Leani Stassen said the focus will be on ensuring a stable transition within a strong governance framework.
“The scheme’s priority is to ensure a stable and well-governed transition that supports the ongoing protection of members’ interests and the effective administration of the scheme.
“Our focus will be to work collaboratively with Medscheme within the scheme’s governance framework, ensuring appropriate oversight, regulatory compliance, and operational continuity.”
Merger follows protracted approval process
The amalgamation between Sisonke Health Medical Scheme and Lonmin Medical Scheme, which took effect on 1 April 2025, followed a lengthy regulatory process.
The merger was first proposed in 2021 but was only finalised after the Appeals Board set aside an earlier determination, paving the way for approval by the Registrar of Medical Schemes.
Although limited information has been made public on the reasons for the appeal, the process points to the level of scrutiny applied to the transaction, particularly in relation to governance, member impact, and financial sustainability.
The merger combined two restricted, employer-based schemes in the mining sector, requiring the integration of benefit structures, governance arrangements, and healthcare delivery networks.
A review of successive Council for Medical Schemes (CMS) Industry Reports shows that the merger followed several years of instability, beginning in the immediate aftermath of Covid-19.
The 2022 CMS Industry Report reflects an industry emerging from pandemic-related disruption, characterised by financial strain, shifting membership dynamics, and rising healthcare costs.
Within this environment, restricted schemes – particularly those tied to specific industries – were exposed to changes in employment patterns and affordability pressures as the economy adjusted.
By 2023, these pressures were clearly visible at scheme level. Sisonke recorded a 13% decline in membership, placing it among the most sharply contracting schemes in the industry.
Lonmin Medical Scheme, meanwhile, reported modest growth of about 5%, suggesting some short-term resilience in the immediate post-Covid period.
That position proved short-lived.
Data from the 2024 CMS Industry Report shows that by the following year, both schemes were in decline.
Sisonke’s contraction persisted, albeit at a slightly reduced rate of –10%, while Lonmin shifted from growth into contraction, recording a –5.9% decline.
Combining the schemes allows for a larger risk pool, better scale, and stronger negotiating leverage with providers.
Medscheme lands Sisonke as Bonitas dispute continues
The Sisonke mandate comes at a pivotal moment for Medscheme.
The administrator is in the process of losing its largest client, Bonitas Medical Fund, with the transition to Momentum Health scheduled for 1 June. That transition is proceeding, even as Medscheme’s legal challenge continues to move through the courts.
An earlier attempt to urgently halt the implementation was removed from the urgent roll, with the matter expected to return to court once procedural issues are resolved.
At the centre of the dispute is not only the award of the Momentum contract itself, but the broader procurement process that preceded it.
Medscheme is arguing that the new administration contract should not be implemented while a CMS regulatory investigation into earlier tender processes is still under way. Bonitas, however, maintains that the Momentum appointment was lawfully awarded and is separate from those earlier tenders.
Despite the unresolved litigation, Momentum Health has continued preparing for implementation.
“We respect the ongoing legal process; however, it would be irresponsible not to proceed with the transition while the courts make their determination,” said Damian McHugh, chief marketing officer at Momentum Health.
Read: Bonitas transition proceeds as administrators outline plans amid legal uncertainty
The scale of the Bonitas contract means the stakes are high.
Bonitas, which covers more than 730 000 beneficiaries, is one of the largest open medical schemes in the country, making its loss a significant blow to Medscheme’s scale and market share.
Sanlam, which holds a controlling stake in AfroCentric – Medscheme’s parent company – has indicated that the shift could place jobs at risk, given the operational capacity built around the contract, although it is exploring redeployment options within the group.
The Sisonke mandate does not replace Bonitas in scale, but it does provide Medscheme with an important foothold as it works to stabilise its position in a consolidating market.
