(Photo: iStock) 
It’s that time of the year when medical schemes are announcing their contribution increases for the next year and vying for your membership.
Most increases amount to just less than 10%. However, you need to consider not just the medical scheme, but the actual cover you are accepting for what you are paying.
It is important to bear in mind that these are the average-weighted contribution increases, so the actual increase in your contribution may be higher or lower, depending on which scheme option you decide to choose.
Discovery Health Medical Scheme is the only scheme so far to have announced a deferred contribution increase, which will kick in from 1 April next year. Discovery is able to do this because of a strong solvency position, which is projected to remain well above 30%.
Dr Ron Whelan, chief executive of Discovery Health, the administrator of the Discovery Health Medical Scheme, says this strategic use of excess solvency enables the scheme to offer members “meaningful financial relief without compromising its long-term sustainability”.
The Discovery Health Medical Scheme has leveraged its robust solvency position previously by deferring the contribution increase during the Covid-19 pandemic three times – in 2021, 2022 and 2023.
Deferring the contribution increases for next year from 1 January to 1 April delivers significant value to members who will continue paying 2025-level contributions for the first three months of 2026.
For example, a family of four on Classic Comprehensive will save more than R5,100, whereas a family of three on the Classic Saver plan will save more than R2,000 during this period.
“Medical inflation is a global challenge affecting all health systems, not just medical schemes in South Africa,” says Whelan.
The Council for Medical Schemes (CMS) noted last month that the average industry contribution increase rate of 10.1% for 2025 was 7.1% higher than the projected average inflation of 3%.
“The higher price differential between annual medical scheme contribution rate increases and inflation places an undue financial burden on cash-strapped consumers, especially when annual salary adjustments are unlikely to keep pace with inflation. Persistently above-inflationary contribution increases also serve as a barrier to entry for potential new members due to budget constraints,” said the CMS.
At the beginning of September, the CMS noted that steep increases in the price of electricity and high food inflation made it evident that most household budgets are significantly constrained. ?To ease the financial strain on members of medical schemes and the risk of losing health insurance, the CMS hereby recommends that the contribution increase and cost assumptions for tariff increases for the 2026 benefit year be limited to 3.3% plus reasonable utilisation estimates," the regulator said.
“Discovery Health Medical Scheme data show that certain primary healthcare needs among young families are universal – over 92% claim for GP consultations and medicine each year,” says Whelan.
Annual contribution adjustment
Damian McHugh, chief marketing officer at Momentum Health, says the scheme’s average weighted 9.9% annual contribution adjustment for 2026 and benefit enhancements are designed to help members take proactive ownership of their health while prioritising value and long-term stability.
“This adjustment reflects industry-wide trends such as medical inflation and rising usage, which continue to drive up healthcare costs. All members have the ability to earn more than R1,000 per adult in their family per month, reducing their total spend significantly,” he explained.
Jeremy Yatt, the principal officer at Fedhealth, says the scheme has achieved its lowest average-weighted contribution increase in years – 9.6%.
Beyond 2026, Fedhealth and Medshield will amalgamate, subject to regulatory approval. Once finalised, the combined scheme will become one of South Africa’s top four open medical schemes – serving more than 135,000 principal members and 250,000 beneficiaries, and holding R3.3-billion in reserves.
With a projected solvency ratio of 36.9%, the new entity will bring stronger negotiating power, improved sustainability and even more value for members in an evolving healthcare landscape.
Profmed’s average increase is 6.76%. Profmed chief executive Craig Comrie says being a restricted scheme means it can design benefits that are both flexible and sustainable while keeping contributions lower and still offering comprehensive coverage where it is needed most.
Bonitas, which has reserves of R9-billion, says its average-weighted contribution increase of 8.8% ensures that members continue to have access to quality healthcare without unnecessary financial strain.
“Every benefit adjustment in the 2026 range was guided by the data we see daily from our members’ health needs,” says Lee Callakoppen, the principal officer of Bonitas Medical Aid. “We looked at the current usage patterns of members and claims data, and are confident that our offerings are aligned to the care our members need.
“We have expanded preventative care and digital access because these are the areas that make the most immediate difference in keeping members healthier, lowering out-of-pocket expenses and reducing the long-term burden of chronic conditions.” DM
This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R35.
