Managing your medical expenses

Taking charge of your medical expenses has become increasingly important as healthcare costs continue to rise. Finding the right healthcare cover, that is affordable and meets your healthcare needs, is the first step.  At this time of year, medical aid members are reviewing their options to ensure they make the right decision regarding access to the highest quality of healthcare, for the year ahead. It’s a delicate balancing act that needs to support your physical, mental and financial wellbeing. 

Lee Callakoppen, Principal Officer of Bonitas Medical Fund, provides some insights into how you can save on healthcare costs by using networks, Designated Service Providers (DSPs), opting for virtual care and generics to stretch your benefits. 

Using networks 

One way of reducing monthly medical aid contributions, without compromising on care, is to use a network plan. Generally, these are around 15% cheaper but, you must agree to use network hospitals. 

‘We implement networks to negotiate the most favourable tariffs for our members so they can avoid out-of-pocket expenses and get more value,’ explains Callakoppen. ‘Using networks also means you can reduce or eliminate co-payments.

‘Members are seeing the value of hospital networks,’ he says. ’Around 1.2 million open scheme members are on a network option, accounting for 53% of the industry.’  

If you choose to go with a network plan, ensure there are doctors and facilities in your area.  Check what co-payment might have to be paid for not using a DSP or network. Don’t forget that network options are waived for emergencies.

Co-payments

Medical practitioners and hospitals often charge more than medical aid rates, this means medical schemes seldom cover the entire bill.  A co-payment refers to the outstanding portion of the account, for which you will be responsible.  Co-payments vary from one scheme to another.

Tariffs and rates of payment 

Every medical scheme has a rate of payment: The amount the scheme will pay for that service.  Some providers charge different rates known as the Scheme Tariff. Members often misunderstand that 100% of the scheme tariff/rate doesn’t necessarily mean 100% of the account or what you will be charged.  Read the details of your plan carefully and know what rate is being paid and the benefit limits to avoid any surprises.

Virtual has the Edge 

Technology is driving innovation and with the introduction of virtual integration and digital interventions, this is an ideal way to access healthcare, while stretching your benefits and minimising your monthly contribution costs. 

Designated Service Providers (DSPs)

Healthcare costs in South Africa are unregulated, which means providers are free to charge any tariff, However, by using DSPs you can limit out-of-pocket expenses and co-payment and stretches your annual benefits.

‘Bonitas networks include over 4 000 GP practices, a pharmacy network of around 2 500 to dispense chronic, acute and over-the-counter medicine, around 3 000 dental practices and an optical network of over 2 300 practices.

Use generics 

A generic is the exact copy of brand-name drugs.  They have the same dosage, intended use, effects, side effects, route of administration, risks, safety and strength as the original. 

But they are much cheaper than the originals. – on average between 30 and 80% less.

The Medicines Control Council (MCC) carries the responsibility of making sure that generic drugs are safe and effective in South Africa. Generic manufacturers have to prove their medicine is bioequivalent to the innovator brand before a product is allowed into the South African market. 

Benefits

The benefits you receive vary depending on the plan you choose, make sure you read the fine print to understand what is and isn’t covered. 

Gap Cover

Gap cover is an insurance policy, designed to cover the difference between what the medical scheme pays and the service provider charges for in-hospital procedures/treatment and specified outpatient procedures.

The advantage of having a Gap Cover is that you are insured against some of these additional costs.  However, never assume that all costs will be covered as the payment options depends on the product you have taken out, which is subject to limits and exclusions and you might still be asked for a co-payment.

Medical savings 

A medical scheme allocates an annual fixed amount for medical savings – you need to know what this allocation is and whether you feel it will be adequate for your needs and you are able to tap into your savings for a number of medical expenses.

Managed Care

One of the key healthcare trends is the rise in non-communicable or lifestyle diseases, such as diabetes, high blood pressure and cancer. ‘80% of these conditions are caused by lifestyle risk factors,’ explains Callakoppen, ‘which is why we offer a range of Managed Care programmes aimed at assisting members understand and manage chronic conditions include cancer, diabetes, HIV/AIDS, mental health and back and neck pain.’  

To this end use the supplementary benefits offered by your medical aid to save on significant day-to-day expenses such as: Blood pressure medication, cholesterol, blood sugar and Body Mass Index (BMI) measurements through to mammograms, pap smears and prostate testing.

You can ‘work smart’ with your medical aid benefits. And wisely. Not only will you have access to quality healthcare but you will be able to extend your benefits. 

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Bonitas 2022 contributions continued for 2023!

 Bonitas Medical Fund, one of the leading medical schemes in South Africa, announced its 2023 product line up today. Lee Callakoppen, Principal Officer of Bonitas says, ‘Our average increases for the year would have been 5.9% – well below the current inflation rate of 7.6%. The good news is that we’ve put a price freeze on contributions for the first quarter of 2023, to offer our members some respite. This effectively means an increase of 4.8% over the 12 months. We have also shared exactly what members can expect to pay from 1 April 2023, so that they can make informed decisions.

Bonitas celebrated its 40th anniversary this year and has evolved and expanded its capabilities over the past four decades in response to the needs of a growing membership base. 

‘It’s always a delicate balancing act between keeping increases as low as possible while maintaining the stability of the Scheme,’ says Callakoppen. ‘The guidelines, set out by the Council for Medical Schemes (CMS) in Circular 44 of 2022, requested medical schemes to keep contribution increases for 2023 below CPI. However, over the past decade medical scheme contribution increases have outpaced inflation by around 4%. We are delighted to have kept these well below CPI itself. In fact, by applying very low contribution increases since December 2020, the Scheme has effectively passed R1.4 billion in savings back to members. 

And, with the challenges we’ve seen recently in the healthcare industry, we know that promoting sustainability is key. So, we’re happy to boast excellent financial indicators from high solvency ratios, strong reserves and a high claims-paying ability. Not only is the Scheme financially sound with over R7.4 billion in reserves but, over the last 36 months we have signed up 190 000 new members. This figure is significantly higher than the size of most schemes in the industry.

Even better for sustainability is that the average age of our new members is around 15 years younger than the current membership. It reinforces the fact that we are succeeding in attracting a younger, healthier profile, which is coveted across the industry. 

The future of healthcare is anchored on primary and preventative care as well as sustaining well-being, as opposed to responding to illness. One of the key healthcare trends is the rise in non-communicable or lifestyle diseases, such as diabetes, high blood pressure and cancer. 80% of these conditions are caused by lifestyle risk factors which is why we offer a range of Managed Care programmes aimed at assisting members understand and manage their conditions.

Cancer care

Cancer prevalence is one of the key concerns facing South Africans and is increasing year on year. Last year, we announced our partnership with the South African Oncology Consortium – the largest network of oncologists in the country to enhance the offerings of our cancer programme including screening for early detection, treatment and palliative care. For 2023 we have restructured benefits to be unlimited for PMB cancers, on all options.

Diabetes

The latest data from the South African Health Quality Assessment, shows that Bonitas has an effective disease management programme and better outcomes than the industry standard for diabetic members, with improved metrics for Hb1Ac, statins and cholesterol. 

But, as we always look for ways to improve, we are proud to introduce a benefit of R51 000 per family per year for an insulin pump or continuous glucose monitor for type 1 diabetics over 18 years.

Mental health

We are pleased to announce that we’ve introduced an innovative new digital solution, called Panda, to support our members in managing their mental wellness. Panda, a free to download app, offers everything from audio sessions with peers and mental health experts to one-on-one virtual consultations with mental health professionals. We encourage our members to complete a mental health questionnaire in the Bonitas Member App to assess their mental health status. Panda will be available from October 2022.

Benefit Booster

Launched last year, the Benefit Booster was one of the most innovative changes to hit the medical schemes industry and aimed at supporting our preventative care strategy. It unlocked R446 million in additional benefits for members to extend their day-to-day benefits. For 2023, we’ve opted to adjust the benefits limits in line with utilisation with enhancements seen on several plans.

Designated Service Provider (DSP) 

We implement networks to negotiate the most favourable tariffs for our members so they can avoid out-of-pocket expenses and get more value. These networks are carefully selected to maintain high levels of healthcare, aligned with our brand promise of providing quality healthcare. We have restructured our options to include a wider hospital network component. In 2023, 85% of our members will be within a 30km radius of a network hospital – with a presence across all nine provinces in line with the footprint of our member base. 

This includes a GP network of over 4 400 of the most efficient practices in the country, an extensive pharmacy network, with around 2 500 practices to dispense chronic, acute and over-the-counter medicine through Scriptpharm. Our dental network, through DENIS, is one of the largest on the continent – providing access to around 3 000 practices while our optical network through PPN gives members access to over 2 300 practices.

Medicine formulary

We have aligned our medicines formulary to the WHO’s Essential Medicines List (EDL) to promote affordability and accessibility to clinically approved medicines, in support of Universal Health Care and promotion of medicine adherence for our members. 

Hospital-at-home

The technology-enabled Hospital-at-Home service brings all the essential elements of in-hospital care to a patient’s home, without moving away from evidence-based clinical protocols and state-of-the-art 24hr vital sign monitoring. 1 200 members have used the offering to date – equating to around 6 000 days in hospital. We are extending the offering to include: A programme for re-admissions, screening and disease prevention, alternative to stepdown facilities and kidney dialysis at home.

Savings 

We’ve amended our rules to allow members to use their savings as they deem fit for the new year. This allows members flexibility as they can use their saving for co-payments and avoid out-of-pocket expenses on certain plans. We’ve also increased savings by up to 9.4% – depending on the plan selected. Day-to-day benefits have been restructured and increased on our traditional plans as well.

Exclusive offers and discounts

With the current economic challenges facing the country, we know everyone is constantly looking for added value and ways to save money every month, including our members. This dovetails with our objective of providing members with access to additional value, through exclusive offers and discounts, that adds meaning to their lives.

For 2023, we’ve partnered with top providers in the industry for exclusive offers across a range of categories including: Lifestyle, wellness, gap cover, short-term insurance, life insurance and credit solutions.

As South Africans face increased challenges around inflation, fuel and electricity hikes we remain committed to providing quality healthcare, at affordable prices, while ensuring the sustainability of the Scheme. 

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Tackling women’s health holistically

‘A woman’s health is her Capital’

As far back as 2014 at the World Health Organization’s (WHO) ‘Partnership for Maternal, Newborn and Child Health Forum’, South Africa stated their alliance with WHO’s statement and said, ‘the health of mothers and their children is key to achieving development equity.’

Which is why Bonitas Medical Fund, the Medical Aid for South Africa, has teamed up with CareWorks, to bolster its mother and childcare benefits and introduce a new Female Health Care Programme. With this renewed commitment to the health and wellbeing of women and toddlers, the Scheme will shine a light on the importance of preventative care and empower women to prioritise their health.

‘In South Africa, women face a range of health challenges influenced by socioeconomic, cultural and environmental dynamics at play,’ says Dr Themba Hadebe, Clinical Executive at Bonitas. ‘Many of these healthcare factors are unique to women. Early disease detection and appropriate care programmes are proven key factors in improving treatment outcomes and prognosis.

Dr Hadebe says, ‘It is common knowledge that women often put their own health needs aside to care for their families. This programme will pro-actively assist women and provide them with support, to ensure that they access prevention services when they need to, as well as treatment plans.’

Top health issues in South African women are:

Non-Communicable Diseases (NCDs)

Diabetes in South Africa’s is the second deadliest disease and is also the leading cause of death among women in the country. 68% of women are obese, which is a strong risk factor for Type 2 diabetes. In addition, it is estimated that 10% of pregnant women in South Africa have gestational diabetes, which may go undiagnosed. This evidences the urgent need for screening and diagnosis. 

Breast and Cervical Cancer

The statistics are stark: 1 in 6 women worldwide is estimated to develop cancer during their lifetime. By 2040, there will be a projected rise to 30 million new cancer cases amongst women globally. Screening services are encouraged for early HPV (Human Papilloma Virus) detection and breast cancer diagnosis. 

Mental Health

Approximately 25.7% of South Africans are affected by probable depression, with similarly elevated levels of anxiety, particularly among women. These rates are influenced by socio-economic status, adverse childhood experiences and educational levels.

HIV/Aids

South Africa has one of the highest HIV prevalence rates in the world – with women, especially young women, being disproportionately affected. Of the 7.3 million adults living with HIV, 64% are women.

According to Dr Mizpah Moru, the Clinical Service Manager of CareWorks, ‘The programme is focussed on educating and empowering women to take control of their health and to address any barriers that may stop them accessing health services. ‘We have a highly skilled female team of clinicians who understand the specific healthcare needs of women.’

Online Assessment and Preventative Screening

There are various modules in the Self Health Evaluation (SHE) – each are educational and designed to alert potential red flags related to the likes of cardiovascular disease, hypertension and diabetes. Other modules deal with prevalent cancers, mental health, pregnancy and communicable diseases like HIV, as well as screening questions for TB and STIs.

SHE and risk identification will enable targeted messaging to members. Screening results will trigger a support process to assist members in accessing appropriate, targeted care programmes. ‘We’ve taken proactive steps to address their unique healthcare needs. Our aim is to provide inclusive, tailored healthcare solutions at every stage of life,’ says Dr Hadebe. 

Female members will be encouraged to access their Bonitas benefits to:

  • Promote preventative care strategies for both females and toddlers 
  • Detect non-communicable diseases such as hypertension, diabetes, mental disorders, cancers, etc. 
  • Help females plan appropriately during their reproductive ages
  • Help expecting mothers to detect and manage any risks and complications as early as possible in their pregnancy
  • Improve access for females and toddlers to essential care
  • Improve parent education and awareness about toddler care

Expansion of the Maternity Programme 

The comprehensive Maternity Programme includes support for new parents with milestone reminders for children under three, immunisation reminders and online screenings for infant and toddler health. 

Enhanced support for expecting mothers, includes:

  • Early identification of high-risk pregnancies
  • Weekly engagement for high-risk pregnancies
  • Post-childbirth follow-up calls
  • Online assessments for pregnancy and mental health
  • Midwives and nursing sisters will provide nurturing and caring support to women who have suffered a miscarriage and assist them in working through both the physical and mental issues associated with the loss of their baby. 
  • Support will be offered to parents of neonatal babies 

The programme also includes a library of female specific health topics – with a monthly focus – screening reminders and support, all communicated through SMS, WhatsApp, emails, calls and other existing digital platforms. 

‘The aim of the new Female Health Care Programme is to raise awareness and promote education around health and wellness,’ says Dr Hadebe. ‘It’s about influencing behaviour positively and encouraging early screening and preventative services. Importantly, it is also about providing inclusive, tailored healthcare solutions at all stages of life, to help members live their healthiest life.’

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Medical aid myth busting: The misunderstandings we’re leaving behind in 2026

From tracking steps and calories to getting the gains at the gym and taking care of mental and emotional wellness, South Africans have never been more health conscious. At the same time, there is a growing disconnect in how we perceive the systems that protect that health.  

As we step further into 2026, it’s important to debunk the myths around medical aid that often cloud our judgement when it comes to looking after our own health and that of our families. Cover without interruption should be high up on our list of resolutions this year, and to achieve this, it’s important that South Africans get the facts straight.

Myth 1: Medical aid is a luxury

The most pervasive myth is that medical aid is a luxury. The data, in fact, suggests otherwise. According to the Council for Medical Schemes (CMS) 2024 Industry Report, hospital expenditure remains the dominant cost driver in South Africa, accounting for nearly 36% of total benefits paid.

‘Medical aid acts as a bridge to immediate, specialised intervention,’ says Lee Callakoppen, Principal Officer of Bonitas Medical Fund. ‘For a scheme like Bonitas, being a member is a guarantee of access to a network of private facilities when time is the most critical variable.’

Myth 2: Plan adjustments mean lower quality

There is a common fear that moving to a different plan within a scheme is a step backwards. In reality, the healthcare market is defined by customisation, allowing you to choose a plan that fits your specific lifestyle and healthcare needs without paying for bells and whistles you don’t use. 

This is best seen in the rise of options that make strict use of networks and digital-first plans like Bonitas’ BonCore that was unveiled in September last year. Network options offer reduced monthly premiums by requiring members to use a specific group of healthcare providers with whom preferential rates have been negotiated. BonCore takes this further by offering a digitally enabled hospital plan that combines unlimited hospital cover with virtual-first primary care. This means that simple GP consultations happen via video link, which lowers costs and increases convenience while still providing a Benefit Booster for physical visits and specialised tests.

Myth 3: Secondary products can stand alone

A dangerous trend has seen some people viewing gap cover or health insurance as a replacement for full medical aid membership. While these tools have their place, they are designed as supplements and not replacements.

Gap cover, for instance, is a vital tool for managing specialist shortfalls, but it relies on the foundation of a medical aid to function. Without that foundation, the protection is incomplete. Real security comes from a holistic ecosystem, with Prescribed Minimum Benefits (PMBs) ensuring that a pre-determined list of chronic conditions and emergency procedures are covered by law, regardless of the plan you choose.

Myth 4: Public-private hybrids are a universal quick fix

While the integration of public and private care is a key pillar of national health policy, the immediate reality for many in 2026 comes down to capacity. Public facilities are under significant strain, and while insurance products linked to public care provide a basic entry point, they often lack the elective agility that private medical aid provides.

In simple terms, this means that while you might be covered for a life-threatening emergency, you could face a very long wait for elective procedures like hip replacements, cataract surgery or specialised scans.

Securing private care through a scheme with a broad national footprint allows for proactive health management and the ability to treat a condition before it becomes a surgical emergency.

Myth 5: Medical schemes prioritise the young and healthy

South African medical schemes operate on a principle of social solidarity. This means that all contributions go into a collective pool of funds to be used by all members, as and when needed.

As per the Medical Scheme’s Act 131 of 1998, open schemes are legally required to accept all applicants. In fact, Bonitas’ 2026 strategy emphasises preventative care for all life stages, which includes a series of health screenings, vaccinations and wellness assessments. This ensures that the Scheme’s R9 billion in reserves is used to keep all members healthy for longer, regardless of age.

‘Ultimately, being a member of a medical aid is about having a partner that bridges the gap between health consciousness and health security. We must move beyond viewing healthcare as a grudge purchase to seeing it as a vital tool for long-term resilience,’ concludes Callakoppen.

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