Medihelp Medical Scheme
Open scheme · Established 1905 (one of South Africa's oldest schemes) · 100,000+ principal members · 214,000+ beneficiaries
Overview
Medihelp Medical Scheme is a registered non-profit open medical scheme regulated by the Council for Medical Schemes under the Medical Schemes Act. Founded in 1905, it is one of the oldest medical schemes in South Africa. Medihelp is a mid-tier open scheme with a strong historical presence in the public-sector and government-employee market.
Source: Medihelp Annual Report 2023; Medihelp company profile.
Membership Profile
Medihelp exceeded the 100,000 principal-member mark during 2023 with 100,198 principal members and over 214,000 beneficiaries — a significant growth milestone for a mid-tier scheme.
Membership requirements
Open to any South African resident; no employer or industry restrictions. Standard Medical Schemes Act waiting periods apply.
Source: Medihelp Annual Report 2023.
Financial Health
Important context: Medihelp's statutory solvency ratio fell to 20.99% at year-end 2024 (2023: 23.84%; 2022: 33.93%), placing the Scheme below the 25% statutory minimum required by Regulation 29(2) of the Medical Schemes Act. The Scheme has stated that its solvency ratio is expected to recover to the legally required 25% by the end of 2025. The CMS has not announced any formal regulatory intervention beyond the standard reporting and monitoring required when a scheme falls below the statutory threshold.
Reliance on investment income
The Scheme has reported strong cost-containment performance in 2024 (claims expense per beneficiary +6%, well below medical inflation) which it cites as the basis for its recovery trajectory. Members considering Medihelp should review the Scheme's most recent quarterly CMS submission for the current solvency position before joining.
Source: Moneyweb, "Two medical schemes fail to maintain prescribed solvency ratio"; Medihelp 2026 plan announcement; Moonstone — Medihelp 2026 contribution increases.
Plans & Options
Medihelp offers 11 plan options for 2026, ranging from a basic flat-rate option to a comprehensive top-tier plan.
| Plan | Category | Day-to-day model | From (2026) |
|---|---|---|---|
| MedMove | Entry-level network | Network primary care | From R804 (single) |
| MedVital Elect | Network hospital + chronic | Hospital plan, Medihelp network | R2,412 pm |
| MedVital | Hospital plan, any provider | Hospital plan | R3,096 pm |
| MedAdd / MedSaver | Savings | MSA | Mid-tier |
| MedReach | Hospital + chronic + limited DTD | Insured network DTD | Mid-tier |
| MedPrime | Comprehensive savings | MSA + ATB | R5,790 pm |
| MedPlus / MedElite | Top-tier comprehensive | MSA + unlimited ATB | Up to R8,922 (MedElite, single); to R15,486 family |
Source: Medihelp 2026 plan comparison; medicalaid.com Medihelp plan pages.
Key Benefits & Differentiators
One of SA's oldest schemes. Medihelp's 120-year operating history is unusual in the South African medical scheme market and is one of the Scheme's primary positioning points.
MedMove flat-rate entry plan. At R804 per principal member, MedMove is among the lowest-contribution insured medical scheme plans in South Africa, providing managed primary care and PMB cover via a defined network.
Conservative claims management in 2024. Despite solvency pressure, the Scheme reported relevant healthcare expenditure growth of only +6% per beneficiary in 2024 — well below medical inflation — reflecting underlying cost-containment discipline.
Chronic, oncology and mental health
All plans cover the 27 PMB Chronic Disease List conditions. Mid-tier and above add a defined additional chronic list. Oncology cover follows defined Rand limits with managed-care protocols. Mental health is covered to PMB level on all plans, with outpatient sessions on mid-tier and above.
Source: Medihelp 2026 plan brochures; Medihelp Annual Report 2023.
Wellness & Loyalty
Medihelp offers a wellness benefit on every plan, covering basic preventive screenings. The Scheme does not operate a points-based rewards programme comparable to Vitality or Multiply.
Claims & Service
Claims can be submitted via the Medihelp member app, the online portal, email, or in person at Medihelp offices in Pretoria.
Service details
Dispute resolution follows the CMS process: internal dispute committee → CMS adjudication.
How the Scheme Is Set Up
Medihelp's plan range is designed around: price-sensitive members at the entry level (MedMove at R804 is among the lowest-cost insured medical-aid options in SA); members preferring a network-based hospital plan with chronic cover (MedVital Elect); and members on top-tier comprehensive plans seeking established scheme heritage. Prospective members should weigh the Scheme's strong cost-discipline performance against its current sub-25% solvency position and review the Scheme's most recent published solvency disclosure before joining.
Source: Medihelp 2026 plan announcement; Moneyweb solvency coverage.