# Council for Medical Schemes, South Africa

Source: https://onco.cc/institutions/council-for-medical-schemes/  
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## TL;DR

The regulator of South Africa's private medical schemes, which covered about 9.17 million people in 2024. It enforces the Prescribed Minimum Benefits, the conditions every scheme must pay for in full, which include the treatment of most cancers that can be treated.

## Summary

The Council for Medical Schemes regulates medical schemes under the Medical Schemes Act, 1998 (Act No. 131 of 1998), from Eco Glades 2 Office Park, Centurion. Its annual report for 2025/26 records 70 registered schemes (16 open and 54 restricted), 36 administrators and about 9.17 million beneficiaries in 2024, up from about 9.13 million in 2023, against a statutory solvency minimum of 25 per cent that the industry exceeded at 40.87 per cent. Benefits paid rose 8.52 per cent to R259.3 billion in 2024, and out-of-pocket spending by members reached R46.3 billion.

Every scheme option must cover the Prescribed Minimum Benefits: emergency care, a list of diagnosis and treatment pairs (271 conditions in the 2025/26 report) and 26 chronic conditions. The council's consumer guide says schemes must pay for these in full, without a co-payment or deductible, provided the member uses the scheme's designated provider, formulary and protocols. The list pairs cancers by site with medical and surgical management including chemotherapy and radiotherapy, each qualified as treatable, and adds cervical and breast cancer screening. Spending on these benefits rose 9.09 per cent to R135.66 billion in 2024, 52.31 per cent of all benefits paid; the council is reviewing the package.

The National Health Insurance Act 20 of 2023 provides that, once national health insurance is fully implemented, schemes may offer only complementary cover for services the fund does not reimburse. The coordinates are a Centurion centroid, not the street address.

## Fields

- Kind: Institution
- Last checked: 2026-11-04
- Also known as: CMS; Council for Medical Schemes
- City: Centurion, ZA
- Type: government
- Website: https://www.medicalschemes.co.za

## Sources

- Council for Medical Schemes: Annual Report 2025/26 (PDF, via Parliamentary Monitoring Group): https://static.pmg.org.za/CMS_2025-26_AR.pdf
- Council for Medical Schemes: Prescribed Minimum Benefits and chronic medication, consumer guide (PDF): https://www.medicalschemes.com/files/Consumer%20Education%20Material/PMB_ConsumerGuideBookLet.pdf
- National Health Insurance Act 20 of 2023, section 33 (PDF): https://www.gov.za/sites/default/files/gcis_document/202405/50664nathealthinsuranceact202023.pdf

## Connected records

- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Cervical cancer](https://onco.cc/cancers/cervical/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- institutions: [National Department of Health, South Africa](https://onco.cc/institutions/south-africa-national-department-of-health/), [South African Health Products Regulatory Authority (SAHPRA)](https://onco.cc/institutions/sahpra/)

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