Why we built this.
Most "best medical aid" rankings online are based on customer reviews, brand sentiment, or undisclosed methodology. Customer reviews skew negative (people complain more than they compliment), brand sentiment rewards advertising spend, and undisclosed methodology can't be challenged.
We took a different approach. The Council for Medical Schemes (CMS) — the statutory regulator of every scheme in South Africa — publishes the same audited financial and operational metrics for every registered scheme, every year. We use those, with fixed thresholds and weights that are published right here on this page.
Our four metrics.
Each metric is scored from 1 to 5 stars in 0.5-star increments, then weighted into an overall score.
1. Solvency ratio
Weight 30%What it is: The scheme's accumulated reserves divided by gross annual contributions, expressed as a percentage. The CMS regulates a minimum of 25%.
Why it matters: Solvency is the financial cushion a scheme has to keep paying claims if a bad year hits. A scheme below the 25% minimum is in regulatory trouble; a scheme well above it is built to weather shocks.
Scoring bands (higher is better):
| ≥ 40% | 5★ | Excellent |
| ≥ 33% | 4.5★ | Excellent |
| ≥ 30% | 4★ | Strong |
| ≥ 27.5% | 3.5★ | Strong |
| ≥ 25% | 3★ | Good |
| ≥ 22.5% | 2★ | Fair |
| ≥ 0% | 1★ | Weak |
2. Claims-paying ratio
Weight 30%What it is: The percentage of every rand contributed that is paid back out as claims to members. The remainder funds administration, broker fees, managed-care costs, and any operating surplus.
Why it matters: Members of a not-for-profit scheme should expect the maximum portion of their contribution to come back as healthcare. A higher ratio means more value flows to members; a lower ratio means more is consumed by overheads.
Scoring bands (higher is better):
| ≥ 92% | 5★ | Excellent |
| ≥ 90% | 4.5★ | Excellent |
| ≥ 88% | 4★ | Strong |
| ≥ 86% | 3.5★ | Strong |
| ≥ 84% | 3★ | Good |
| ≥ 80% | 2★ | Fair |
| ≥ 0% | 1★ | Weak |
3. Complaints per 1,000 members
Weight 25%What it is: The number of complaints lodged against the scheme with the Council for Medical Schemes (CMS) in the reporting year, divided by total beneficiaries (in thousands). Source: CMS Annual Report on the Operation of Medical Schemes (the 'Industry Report'), Annexure on complaints by scheme. Direct link: medicalschemes.co.za/publications/annual-reports.
Why it matters: Complaints that reach the CMS are ones the scheme failed to resolve internally. A low rate is a strong indicator of good claims handling and member service.
Scoring bands (lower is better):
| ≤ 0.4 | 5★ | Excellent |
| ≤ 0.6 | 4.5★ | Excellent |
| ≤ 0.8 | 4★ | Strong |
| ≤ 1 | 3.5★ | Strong |
| ≤ 1.5 | 3★ | Good |
| ≤ 2.5 | 2★ | Fair |
| ≤ anything | 1★ | Weak |
4. Member growth
Weight 15%What it is: Year-on-year change in total beneficiaries, expressed as a percentage.
Why it matters: Membership is voluntary. A scheme growing its book is generally one members are choosing on its merits; one shrinking faster than the market is a warning signal worth understanding.
Scoring bands (higher is better):
| ≥ 3% | 5★ | Excellent |
| ≥ 1.5% | 4.5★ | Strong |
| ≥ 0.5% | 4★ | Strong |
| ≥ 0% | 3.5★ | Good |
| ≥ -1% | 3★ | Good |
| ≥ -2.5% | 2★ | Fair |
| ≥ anything | 1★ | Weak |
How the overall score is calculated.
Each metric's stars are multiplied by its weight, summed, and rounded to the nearest 0.5 stars:
Overall = (Solvency × 0.3)
+ (Claims × 0.3)
+ (Complaints × 0.25)
+ (Growth × 0.15)Solvency and claims-paying ratio carry the most weight (30% each) because they speak directly to a scheme's ability to pay your future claims. Complaints (25%) reflect lived member experience. Growth (15%) is a softer market signal and weighted accordingly.
Sources.
Our 2024 figures come directly from each scheme's own audited Annual Financial Statements and Members' / Integrated Reports — published 4–8 months after year-end. We chose this route because the Council for Medical Schemes' 2024/25 Industry Report (with the per-scheme tables) was not yet available at time of writing, and we wanted current numbers rather than 2023 ones.
- Each scheme's audited Annual Financial Statements 2024 (Discovery DHMS, Bonitas, Medshield, Fedhealth, Medihelp, Momentum)
- Each scheme's published 2024 Integrated / Members' Report
- Council for Medical Schemes (CMS) Annual Report 2024/25 (released October 2025) — narrative and industry context
- CMS Annual Report on the Operation of Medical Schemes (the “Industry Report”) — the regulator’s separate publication that breaks complaints down per scheme. We use this exclusively for the complaints metric. The FY2024 edition is pending release.
Every rating cites its specific source (scheme name + report) and links out where available. Direct CMS link: medicalschemes.co.za/publications/annual-reports
Limitations & honesty.
- Data lag. Scheme-level annual reports are released 4–8 months after year-end; the consolidated CMS Industry Report follows another 3–6 months later. The current ratings reflect the most recent audited figures available per scheme.
- Mixed coverage. Not every scheme publishes every metric in their public report. Where a metric is missing, we mark it "Unrated" and re-weight the remaining metrics rather than guess. Momentum Medical Scheme's 2024 figures are still pending publication.
- Complaints data lag. Per-scheme complaint counts only come from the CMS Annual Report on the Operation of Medical Schemes (the regulator’s separate Industry Report). It typically follows the financial figures by 6–12 months. We refuse to estimate complaint rates from scheme press releases or third-party review sites — those are not audited or comparable. The complaints column will populate the moment the FY2024 CMS Industry Report is released.
- Scheme strength ≠ plan fit. A 5-star scheme may sell a plan that's a poor match for your family. A 3-star scheme may have exactly the right plan for you. Use the ratings to filter, not to decide.
- Open schemes only. We currently rate the six largest open schemes available to the general public. Restricted schemes (GEMS, Polmed, Bankmed, etc.) are excluded because they're not options most readers can join.
- Member growth is a soft signal. Schemes shrink for many reasons — including deliberate plan rationalisation. We weight it lightly for that reason.
- We are not a registered financial services provider. Nothing on this page is financial advice. It's an editorial comparison built from public data.
Corrections.
If you spot a number that looks wrong, or a CMS report has been updated, let us know and we'll re-verify. Every rating ships with a last_verified_at timestamp.