CMS Annual Report 2024/25

We are pleased to present the 2024/25 Council for Medical Schemes (CMS) Annual Report, which reflects our resilience, progress, and commitment to protecting the interests of South Africa’s medical scheme members.

The past year was characterised by economic volatility, rising unemployment, and ongoing financial pressures on households, which reduced disposable incomes and placed strain on medical scheme membership. Yet, we remained steadfast in fulfilling our mandate to protect beneficiaries and maintain stability within the medical schemes industry.

In carrying out this role, we regulated 71 medical schemes (16 open and 55 restricted), serving more than 9.1 million beneficiaries through 33 administrators, 43 managed care organisations, and over 10 000 brokers and brokerages.

Under the leadership of our new Chief Executive and Registrar, Dr Musa Gumede, who was supported by a dedicated team of executives and staff, the CMS successfully navigated a challenging year, achieving an outstanding overall performance score of 96.43%, a sharp improvement from 86% in the previous year. This achievement is complemented by an unqualified audit opinion with no material findings on both our financial statements and performance information, reaffirming our position as a trusted and transparent regulator with a strong culture of governance, integrity, and accountability.

Highlights from the 2024/25 financial year include:

• The publication of key policy and research studies on chronic disease prevalence, out-of-pocket expenses, and preventive healthcare to support reforms that promote affordability and equity.
• The resolution of 1 879 of 1 962 registered complaints, with over 80% finalised within prescribed timeframes.
• The management of more than 27 000 calls, 10 800 emails, and 90 in-person consultations through the Customer Care Centre.
• The delivery of 84 education and training activities to empower medical scheme members, trustees and brokers.
• The publication of 12 CMScript editions and the issuance of 534 clinical opinions.
• The strengthening of stakeholder collaboration through 11 new Memoranda of Understanding (MOUs) and enhanced engagement levels.
• Ongoing leadership in Fraud, Waste, and Abuse (FWA) prevention, with a FWA Summit planned for 2026.

With the close of our five-year Strategic Plan, the CMS celebrates the progress made in building a more responsive, people-focused, and transparent regulatory system.

Your trust and support have been instrumental to our accomplishments, and we thank you for walking this journey with us.

Download the full 2024/25 Annual Report here.