According to the latest Medical Aid Insights 2024/2025 report, which analyses two decades of Council for Medical Schemes data, the number of beneficiaries in open medical schemes declined by 1.2% between 2023 and 2024. Restricted schemes, by contrast, grew by 2.4%, meaning overall industry growth came almost entirely from employer-based schemes. Only five open schemes recorded beneficiary growth during the year.
Bestmed was one of them.
Its 2025 financial statements show principal membership increased by 3.6%, from 121 707 to 126 124, while total beneficiaries rose to 262 190, extending the scheme’s record to seven consecutive years of membership growth. The scheme also strengthened its financial position, with insurance revenue, accumulated funds, surplus and solvency all improving during the year.
Bestmed chief executive and principal officer Leo Dlamini (pictured) said the results reflected “the strength of our strategy and the trust our members continue to place in us”.
“In a year defined by affordability pressures, healthcare inflation, and regulatory uncertainty, we remained focused on steady growth, disciplined cost management, and delivering value through our Personally Yours promise.”
The more interesting question is what those results say about the scheme’s long-term sustainability.
The Medical Aid Insights report provides a useful framework. Rather than relying on a single measure, it assesses schemes using factors such as membership growth, demographic profile, claims experience, financial performance, reserves, solvency, and operating efficiency. Bestmed’s financial statements provide an opportunity to examine each of those measures.
Growth is becoming harder to find
The CMS data analysed by Alexforbes shows beneficiary numbers in open schemes declined during 2024, while restricted schemes continued to grow. Much of that growth came from employer-supported schemes such as the Government Employees Medical Scheme.
Bestmed continued to grow in the open-scheme market.
Principal membership increased by 4 417 during 2025, suggesting the scheme continued to attract members despite the increasingly challenging environment for open schemes.
The demographic profile, however, tells a slightly different story.
The average age of Bestmed beneficiaries increased from 36.81 years to 37.25 years during the year, while the proportion of beneficiaries aged 65 and older edged up from 12.71% to 12.78%.
That broadly mirrors the industry trend identified in the Medical Aid Insights report, where the average beneficiary age increased from 34.2 to 34.5 years between 2023 and 2024. The report notes that healthcare costs typically rise by about 2% for every additional year of ageing within a scheme.
Bestmed has therefore continued to attract new members while facing the same gradual ageing of its risk pool affecting much of the industry.
Revenue, reserves, and solvency all moved higher
Insurance revenue increased by 13.8%, from R8.53 billion to R9.7bn. Total assets increased to R6.5bn, accumulated funds rose from R2.83bn to R3.41bn, and the scheme reported a net surplus of R783.4 million, compared with R487.3m in 2024.
The solvency ratio improved from 33.23% to 35.14%, comfortably above the 25% minimum required by the Medical Schemes Act and reversing the decline recorded in the previous financial year.
Investment returns were largely unchanged, increasing only marginally from 8.55% to 8.59%. The stronger surplus therefore appears to have been driven primarily by operating performance rather than stronger investment markets.
Claims grew, but revenue grew faster
Claims are the largest expense for any medical scheme, making them one of the clearest indicators of financial performance.
Bestmed paid R9.49bn in healthcare claims during 2025, up 7.7% from R8.81bn the previous year. Insurance revenue, however, increased by 13.8%, reducing the annual claims ratio from 94.2% to 87.9%.
Dlamini said healthcare inflation remained one of the scheme’s biggest challenges.
“Healthcare inflation remains one of the biggest challenges facing members and medical schemes. Our role is to manage the fund responsibly, negotiate value where we can, encourage appropriate care, and invest in preventative health so that Bestmed remains affordable and sustainable over the long term.”
The broader industry faces the same challenge. The Medical Aid Insights report notes that schemes are managing older memberships while healthcare costs continue to rise, placing sustained pressure on claims expenditure.
Operating costs remained stable
Operating efficiency is another measure of long-term sustainability.
Bestmed’s directly attributable and non-attributable expenditure remained unchanged at 6.99% of gross insurance revenue during 2025, despite continued membership growth and investment in technology, cybersecurity and member services.
Although administration costs increased in rand terms, they remained stable relative to insurance revenue.
Not every option performed the same
The scheme’s overall surplus masks differences between individual benefit options.
Beat3 Network, Rhythm1, Rhythm2, and Pace3 all recorded operating deficits during 2025, while the remaining options generated surpluses.
Dlamini said options are managed as part of the overall scheme rather than as standalone businesses, meaning individual options are not expected to report surpluses every year.
Even so, option-level performance remains worth monitoring. Persistent deficits over several years could eventually require changes to benefit design, contribution levels or option structure.
The longer-term test
Bestmed’s 2025 results suggest a scheme that is performing well in an increasingly difficult market. It has continued to grow while many open medical schemes have struggled to attract members, and it strengthened its financial position through improved operating performance rather than favourable investment returns.
The challenges facing the scheme, however, are largely the same as those confronting the rest of the industry. Healthcare inflation continues to place pressure on claims costs, affordability remains a concern for consumers, and the gradual ageing of the membership base will require careful management over time.
Seven consecutive years of membership growth distinguish Bestmed from most of its open-scheme peers. Maintaining that momentum while preserving its financial discipline is likely to be the clearest measure of the scheme’s long-term sustainability.
