Council for Medical Schemes, South Africa

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.