Independent · Methodology open

    How South Africa's medical schemes really rate.

    An objective star rating for the six major open medical schemes — built from official audited data, not testimonials or marketing. Updated when new reports are published.

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    How to read this: stars rate scheme strength (the company behind the plan), not individual plan benefits. A 5-star scheme can still have a plan that's wrong for you — and vice versa. Always check both. Full methodology →

    Overall ranking.

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    What we measure.

    Four metrics, all sourced from the CMS, all weighted transparently. Full methodology & thresholds →

    Solvency ratio

    30%

    Reserves the scheme holds, expressed as a percentage of annual contributions. The Council for Medical Schemes requires a minimum of 25%. Higher means a stronger financial buffer to pay future claims.

    Claims-paying ratio

    30%

    The percentage of every rand you contribute that gets paid back out as claims to members. Higher means better value flows to you rather than to admin or surplus.

    Complaints per 1,000 members

    25%

    The number of complaints adjudicated against the scheme by the CMS Adjudicator's office, per 1,000 average beneficiaries. Lower means happier members and fewer escalated disputes.

    Member growth

    15%

    Year-on-year change in total beneficiaries. A scheme growing its membership is generally one members are choosing voluntarily — a useful market-confidence signal.

    What these ratings aren't.

    • It's not a plan recommendation. A great scheme can offer a plan that's wrong for your family. Use the calculator for that.
    • It's not advice. We're not a registered financial services provider. We compile public data so you can compare like with like.
    • It's not based on customer reviews. Star ratings on review sites are easy to game. CMS-reported figures are audited, regulated, and consistent across all schemes.
    • It's not opinion. The scoring thresholds are fixed and published. Run the same numbers through them, get the same stars.