KeyHealth to appeal order to fund teenager’s rare-disease treatment
The Appeals Committee found KeyHealth had not shown its proposed care was an effective alternative and ordered it to fund ravulizumab in full.
#medicalschemes
Will cutting minimum medical benefits really make cover cheaper?
The Board of Healthcare Funders wants a leaner PMB package, but the CMS points to provider prices, treatment costs, and other pressures on scheme expenditure.
South Africa’s healthcare laws are stuck in 1998. AI isn’t waiting.
AI is reshaping healthcare and insurance, but outdated legislation, rising costs, and the need for trusted advice raise questions about how far technology can go.
I-GEMS ijonge ukunciphisa imirhumo kwixesha elizayo emva kokuba i-CMS isikhabile isicelo sayo
Esi sicwangciso sithi ulondolozo oluqikelelwa kwi-R1.7 yeebhiliyoni lunokunceda ekuthomalaliseni ukunyuka kwamaxabiso kwixesha elizayo, ngelixa kulungiselelwa iingxoxo ezinzulu nemibutho yabasebenzi.
RAF remains liable for medical expenses paid by schemes, SCA rules
The Court found that two later directives were issued as part of a ‘contrived stratagem’ to circumvent a binding judgment in favour of Discovery Health.
Complaints against medical schemes rise by 24.6%
The CMS’s 2025/26 annual report also highlights progress on a costed primary healthcare benefits package and research into linking administrator fees to outcomes.
Sizwe Hosmed enters 2027 with 40% solvency and self-administration in place
Contributions will increase by between 7.5% and 8.5%, with Essential Copper introducing a lower-income band.
Bonitas raises contributions by 8.7% as new service model takes shape
Four months after a troubled administrator switch, Bonitas is betting on new products, tighter managed care, and a stronger digital offering to rebuild member value and trust.
Discovery Health’s 2027 plans: 8.2% average increase and a new option
Two out of three beneficiaries will face increases below 8%, while Discovery is adding a new lower-cost plan and expanding its personalised health platform.
Medihelp sets 7.5% weighted average increase for 2027
Most members will face increases of 7% or less, while the scheme is adding benefits in mental health, maternity, preventive care, and emergency treatment.
Momentum Medical Scheme to raise contributions by 7.9%
The scheme is pairing the increase with changes to Health4Me and a broader push into prevention, wellness, and digital healthcare.
Bestmed sets 2027 contributions to increase by 7.35%
The scheme is adding a R1 000 healthcare benefit, expanding preventative care, and making targeted changes to medicine, casualty, and clinical cover.
BHF: CMS’s contribution guidance could create unrealistic expectations
The industry body says the 3.8% benchmark does not fully reflect the utilisation and underlying healthcare-cost pressures that schemes face.
Global medical cost growth is cooling. Why isn’t South Africa’s?
Global medical cost growth is easing, but South Africa’s rate remains high – putting medical schemes under pressure to balance rising healthcare costs with affordability in 2027.
GEMS faces scrutiny over costs, governance, and reserves
Parliamentary questions extend from fraud and outsourcing to trustee remuneration and benefit design, while the scheme’s reserves remain below the statutory requirement.
GEMS suspension puts governance under scrutiny
DENOSA says the lack of disclosure over Stan Moloabi’s suspension raises wider questions about the scheme’s leadership, accountability, and handling of member concerns.
Bonitas transition stabilises, but providers still face problems
Operational improvements have reduced the disruption, but short-paid and unpaid claims, tariff discrepancies, and difficult authorisations continue to require attention.
