Co-payments unpacked: the real drivers behind member shortfalls
A practical guide to why co-payments arise, how schemes set them, and how advisers can help clients manage the risk.
#Medihelp
From spouses to parents: understanding medical scheme dependants
This edition of Cover to Cover explains medical scheme dependant rules, required documentation, and how advisers can help clients keep their families covered.
Medihelp to appeal contempt judgment in Elaprase case
Medihelp says it will challenge the judgment while the cost of Elaprase awaits a final decision by the CMS Appeal Board.
Waiting periods – how they affect medical scheme benefits
This edition of Cover to Cover explains waiting periods, helping advisers guide clients on when benefits start and strategies to avoid gaps in cover.
Medihelp limits 2026 contribution increases to as low as 6%
New benefits, flexibility, and holistic well-being support strengthen Medihelp’s role as a healthcare partner, not just a funder.
Decoding medical plans for your clients
The first edition of our new series unpacks the types of medical plan, who they suit, and why the cheapest option isn’t always the smartest choice.
Medihelp’s solvency dips again, but scheme says recovery plan is working
Medihelp says its recovery plan is on track, with strong cost controls, younger members, and CMS-approved funding measures set to restore financial stability by 2026.
Pandemic pricing pains catch up with medical schemes – higher contributions ahead
Three medical schemes fell below the 25% solvency threshold in 2023.
Rising costs prompt members to weigh medical scheme options
Downgrading to a lower plan may appear to be a cost-saving strategy, but it frequently results in increased out-of-pocket expenses.
Bestmed defends 12.75% 2025 contribution hike as industry faces cost pressures
Bestmed states pending rules for low-cost benefit options have further complicated efforts to reduce costs for members.
As medical schemes announce hikes, members brace for tough choices amid rising costs
With major medical schemes reporting average contribution hikes exceeding 9%, members face tough choices in an increasingly unaffordable healthcare landscape.
Will medical schemes adhere to an inflation-linked tariff hike?
The Council for Medical Schemes has advised medical schemes to limit their contribution increases for 2025 to 4.4% plus ‘reasonable’ utilisation estimates.
Medihelp’s solvency ratio drops below threshold amid high claims and rising costs
Medihelp submitted a CMS-approved three-year plan, requiring gradual contribution increases to restore its reserves to the statutory 25% level.
Medical schemes assure members that NHI is a long way off
The expected legal challenges to the legislation and the pressure on the state’s finances could delay full implementation of the system for many years.
Medical schemes experience significant drop in net results for 2022
In 2022, the industry saw a net income of R2.57 billion – down from R12.18bn in 2021 – and faced an operating deficit of R6.155bn, the largest in 23 years.
Medical scheme contribution increases largely surpass recommended 8% hike
The Council for Medical Schemes has withdrawn a directive for Discovery to retract its communication about contribution and benefit changes for 2024.
UPDATED: Withdraw 2024 contribution increase announcements, regulator instructs medical schemes
Discovery has lodged an appeal against a Council for Medical Schemes directive to retract communication to members about its 2024 contribution and benefit changes.
