Circular 35 of 2024: Guidance on contribution increases and benefits changes for 2025

This circular outlines the requirements that medical schemes must adhere to when determining the annual contribution increases and benefit changes for the 2025 benefit year.

One of the primary statutory mandates of the Council for Medical Schemes (CMS), as enshrined in Section 7 of the Medical Schemes Act (131 of 1998), is to protect the interests of beneficiaries at all times and to coordinate the functioning of medical schemes. To this end, CMS’ key objective is to ensure that annual medical scheme contribution rate increases remain affordable to enable equitable access to quality healthcare and the industry’s long-term financial sustainability.

South African consumers remain under serious financial pressure due to the high interest rates over the past years. The cost-of-living crisis due to the current stubborn inflation and the high level of household debt could impact members’ ability to afford medical scheme premiums. Due to financial strain, individuals may choose to allocate their limited income towards other expenses rather than healthcare. In this scenario, health insurance could be perceived as a discretionary or low-priority expense, resulting in interruptions or lapses in medical scheme coverage.

To insulate members of medical schemes against further financial hardship and the risk of losing health insurance, medical schemes are hereby advised to limit the contribution increase and cost assumptions for tariff increases for the 2025 benefit year to 4.4% plus reasonable utilisation estimates.

Download the full Circular here