October 1, 06:50IOL

Bestmed announces average contribution increase of 7.35% in 2027 and expansion of preventive care

Bestmed has announced changes to its benefits plan for 2027, which include an average weighted contribution increase of 7.35% and an expansion of preventive healthcare coverage for members.

The medical scheme stated that these changes are due to member feedback, as well as rising healthcare and living expenses. Leo Dlamini, CEO and Chief Officer of Bestmed Medical Scheme, noted that households in South Africa continue to face pressure from the rising cost of living amid the downturn in global and local economic processes, which affects family finances.

He added that healthcare is a key element of this financial equation. Therefore, the scheme's approach for 2027 involved studying stakeholder feedback and making changes that provide greater choice, strengthen preventive care, and deliver more value while protecting the Scheme's long-term sustainability.

New Best Bucks Benefit

A new benefit called Best Bucks is being introduced, which will provide eligible members with R1000 per family after completing the Tempo lifestyle screenings. These funds can be used to pay for suitable consultations, radiology, and pathology before claims are paid from medical savings or other daily benefits.

Bestmed stated that this benefit aims to motivate members to undergo medical check-ups while providing additional funding for specific medical expenses. Furthermore, in 2027, the scheme is implementing several changes in preventive care.

These changes include coverage for respiratory syncytial virus (RSV) antibodies for infants across all options, pediatric vaccinations under Beat1, and a monthly maternity supplement of R151 under Beat2. Members in the Beat, Pace, and Rhythm2 ranges will have access to two postnatal consultations. Women over 45 in the Pace 1 range will also be able to undergo bone density screening every 24 months.

Bestmed clarified that HPV vaccination will also be extended to men. Infants born between January and May will also receive RSV protection during the infection season. The scheme reported that these preventive care benefits will be funded from the risk pool, according to the rules of the respective benefit option, and not from member savings or daily allowances.

The company noted that the 2027 offering is built on a strong position, as the Scheme continues to grow, maintaining a stable risk profile and a high solvency ratio of 37.3%, significantly exceeding the statutory minimum of 25%.

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iol.co.zaSeptember 23, 13:46

CMS warns of rising medical scheme contributions in 2027, recommends limiting increase to 3.8%

The Council for Medical Schemes (CMS) has published recommendations for 2027, stipulating that increases in medical scheme contributions should be based on a level of 3.8% plus reasonable estimates of service utilization, aligning with projected inflation.

CMS warns that contribution increases above the inflation rate create growing pressure on household finances and may make medical scheme coverage less accessible, especially for younger members.

The Council stated that schemes proposing an increase above the 3.8% benchmark must provide comprehensive business plans supported by clear financial and actuarial evidence.

CMS recommends a 3.8% contribution increase

CMS advised that to mitigate the effects of the cost-of-living crisis, which has been exacerbated by rising fuel prices, contribution increases and expenditure assumptions for 2027 should be based on a 3.8% level. Any additional funds required to cover solvency requirements must be justified by each scheme's financial position.

This recommendation is consistent with the South African Reserve Bank's 2027 CPI forecasts, released in the MPC statement of July 2026, taking into account solvency needs and demographic risk profiles.

The Council added that it uses wage inflation as an indirect indicator to assess the affordability of annual contribution increases. Although private medical inflation typically exceeds CPI by 2–3 percentage points, CMS believes that industry cost increase assumptions should remain tethered to inflation.

Higher increases face extra scrutiny

It was noted that high contribution rates can act as a barrier to entry, particularly for younger beneficiaries, jeopardizing the long-term sustainability of the industry.

The regulator is also aware that some medical schemes may require contribution increases above the CMS recommended CPI-linked benchmark. In such cases, trustees are obliged to submit a detailed business plan backed by clear financial and actuarial justification.

This business plan must fully comply with the South African Actuarial Society's (ASSA) guidelines regarding contribution adequacy, as outlined in the Advisory Practice Note (APN 303).

CMS emphasized that any contribution increase above the recommended benchmark must be accompanied by evidence explaining the necessity of such an additional rise.