SA Medical Schemes are Disappointing Their Members

SA medical schemes are failing to meet their members’ needs and often pay far less than what clients are billed.

South African’s anger with medical aid is growing according to survey results drawn from 3000 members of SA scheme members. The survey was led by the South African Consumer Satisfaction Index (SAcsi).

The overall satisfaction score was a mere 74.1 out of 100. Clearly, SA medical schemes are failing to meet customer needs.

The highest-scoring provider, Bonitas, only scored an average 75.9. While many other leading medical aid schemes scored even lower in the survey.

GEMS scored 74.3 while Discovery Health scored 74.1. Indeed many well-known companies fell below the average. Liberty health scored 71.1 while Momentum Health only scored 69.6.

The goal of the survey was to examine client satisfaction across all categories of medical aid. This includes comprehensive policies, hospital plans and network schemes. The results were startling.

It seems that network schemes had the lowest client satisfaction. Members perceive network schemes as providing the least value for money.

SA medical schemesSA Medical Schemes are Not Meeting Expectations

Professor Adré Schreuder, SAcsi founder and Consulta Research CEO, shed some light on this issue. He said that the low scores were most likely due to clients beliefs about the value of the products.

He also stated that low scores could be addressed by raising the perceived value of products supplied by SA medical schemes.

Schreuder implied that the low scores of network schemes were due to most clients not understanding the co-payment aspects.

Claims Payment Outcry

Survey results suggest that the low ratings are due to most clients experience with claims payment.

The non-payment of claims by SA medical schemes has caused many complaints. Chiefly in cases connected to treatment of conditions relating to PMB (Prescribed Minimum Benefits).

Clients are tired of using their own money to pay their bills. They feel that their aid schemes should rightly cover these costs. Many people are giving up their medical aids and taking up hospital plans from insurance companies instead.

Members feel that SA medical schemes are trying to us the Medical Schemes Act to avoid paying claims.

Because of the backlash against failing aid schemes. Section 27 has asked all members with similar stories to share them with the competition commission. Who is leading an on-going probe into the state of private healthcare in SA.


Section 27, a public-interest law groups goal is to promote equality and social justice within South Africa. The law centre has made its services available in an effort to provide all South Africans with access to cheaper private healthcare.

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All info was correct at time of publishing