Hospital cash plan insurance in South Africa

The funding of health care in South Africa has a long and complex history. Private medical schemes operate as not for profit trusts and pool members’ funds to purchase private health care goods and services. The Medical Schemes Act no. 131 of 1998 is the primary legislation governing medical schemes while the Council for Medical Schemes (CMS) is the delegated administrative body with jurisdiction over these schemes. The majority of the income-rated options as considered in this report provide for benefits at 100% of the scheme rate. As this is below the charging rate of many specialists, income rated options often make use of provider networks and designated service provider (DSP) agreements that facilitate payment in full as long as the member makes use of the applicable networks. Consequently, while medical schemes offer greater protection to members, they are also significantly more expensive and are thus inaccessible to the majority of the population, with only 16% of the population currently being members of these schemes.