Let’s explore the 2025 medical aid review period. This blog will explore:
- Preparing for the 2025 Review Period
- Essential Factors to Consider
- Navigating the Review Process
As we approach the 2025 medical aid benefit review period, it’s important for individuals and families in South Africa to get ready to process the changes that could impact their healthcare cover. This yearly timeframe, from October to December, gives members the chance to assess and modify their plans to better align with their changing needs.
Whether you’re starting a family, managing an illness, or looking for cost-effective medical aid choices, staying well informed is crucial for making informed decisions about your health and finances. In this blog we’ll delve into steps to prepare for the review period and what you can anticipate from medical aid plans this year. Bookmark this blog to stay updated with the latest news and use it as your guide while you prepare for the 2025 review period.
Preparing for the 2025 Review Period
Key Dates to Remember
The medical aid review period generally runs from October to December, however dates may vary between different medical aid schemes. Some schemes allow members to update their plans from 1 October 2024 to 30 November 2024, while others might extend this window until the bill cut-off in December. Any changes will be effective from 1 January 2025. Information from the various medical aid schemes typically starts becoming available around late-September, with the larger schemes releasing their updates first. It is advisable to keep an eye out for notifications from your medical scheme and from trusted sources like MedXpert, and stay informed about these critical dates.
When Will Information Be Available?
The release of information regarding medical aid plans for 2025 varies by scheme. Selected medical aid schemes typically release their updates around late-September, while other schemes may take a bit longer. This staggered release schedule means that comprehensive comparisons across different medical aid options might only be possible towards the end of October. It’s important to stay up to date on release dates so that you can make choices regarding your healthcare cover. Remain attentive to communication and updates from your medical scheme and visit the MedXpert site. For the most recent updates visit our medical scheme benefit review page to keep you updated as the medical schemes release their 2025 benefit offerings.
Understanding Your Current Health Needs
Before delving into the review period for 2025, take a moment to evaluate your health needs. Are you considering starting a family? If that’s the case, it’s important to make sure that your health care plan includes maternity benefits. Have you received a diagnosis for a condition? It’s crucial to verify whether your medical aid covers your condition and offers medication support. If your child has recently reached the age of 21, their age may be impacting your cover or your healthcare plan might need proof that they’re still a dependent, such as proof of study. Many healthcare plans underwent changes regarding preventative care and cover for chronic conditions, and this year could bring further adjustments, such as enhancements in mental health and home-based care benefits. Understanding your healthcare requirements enables you to select a scheme that meets your needs ensuring you have healthcare cover throughout the year.
Essential Factors to Consider
Evaluating Maternity Benefits
When assessing maternity benefits, it’s important to make sure that your healthcare plan covers all the expenses for both before and after childbirth. Look into whether your policy includes visits to obstetricians, ultrasounds and essential tests while you are expecting. Also consider what cover is available for the delivery itself, whether it’s a normal birth or a C-section, as well as the immediate care provided to your new-born straight after their birth.
Some healthcare plans may also offer perks like classes, assistance with breastfeeding and post-natal follow up appointments. These additional benefits can greatly alleviate the stress during this time. Being aware of what services your current plan includes will empower you to make an educated decision that ensures care for both you and your baby.
Chronic Condition Cover
If you have a long-term health issue, it’s important to check whether your healthcare plan caters to your requirements. Cover for chronic conditions should encompass visits to the doctor, essential medications and any needed tests or treatments. Take a look at the list of conditions that are covered by your plan and confirm that your condition is included. Moreover, assess the extent of the cover. Some plans may also provide support services like disease management programmes or access to specialists.
With healthcare costs on the rise, having comprehensive chronic condition cover can greatly lessen your burden while ensuring you get the attention you need. Making sure that your healthcare plan matches up with your health requirements will give you peace of mind and assist you in managing your condition.
Checking Co-Payments and DSP Lists
During the evaluation of your healthcare plan, it’s important to take into account co-payments and the list of Designated Service Providers (DSP). Co-payments entail the amount of costs that you have to cover yourself. These amounts can differ greatly depending on the health plans. It’s crucial to examine the co-payment setup in your existing plan to steer clear of any unforeseen expenses. Another crucial aspect is the DSP list, which includes healthcare providers that your medical scheme has partnered with. Using these providers usually results in lower co-payments and suitable cover as negotiated with your specific plan. However, these lists can change annually based on provider performance and other factors. Ensure your preferred healthcare providers are still on the DSP list for the upcoming year. Keeping track of these elements will help you avoid surprise expenses and ensure you continue receiving care from your trusted providers.
Navigating the Benefit Review Process With A Trusted Partner
Communication from Optivest Health Services
MedXpert, supported by authorised financial services provider, Optivest Health Services, ensures you stay informed throughout the medical aid benefit review period with two rounds of communication. The first round notifies you that the benefit review period is approaching, encouraging you to start evaluating your current health and budget needs. This early notification allows you to begin thinking about any changes you might need to make to your medical aid plan. The second round focuses on scheme-specific updates, providing highlights of any changes made to different medical aid schemes.
This communication includes important details such as the percentage increase in your current plan’s fees. After receiving these updates, you are encouraged to contact Optivest for any assistance or advice. This process is available to all existing clients of Optivest and you could also experience this offering through the MedXpert service offering.
Whether you need help understanding the changes, comparing new options, or adjusting your current plan, MedXpert is ready to support you. This proactive approach ensures you make well-informed decisions regarding your health cover for the upcoming year.
Steps to Engage with an Advisor
Engaging with an advisor during the medical aid review period can help you make informed decisions about your health cover. Start by contacting MedXpert, supported by authorised financial services provider, Optivest Health Services, directly on the MedXpert website or customer service hotline at 0860 860 860. When you get in touch, a consultant will be assigned to assist you personally, catering to your health and financial requirements. You can even ask for a call back so that the consultant reaches out to you at a time that’s more convenient for you.
When you have your appointment, make sure to talk about your health situation, any expected changes and your financial concerns. The advisor will help you understand the updates to your medical scheme, compare different medical aid options, and recommend plans that best suit your requirements. This guided approach ensures you optimise your health cover, avoid unnecessary expenses, and secure the best possible medical aid plan for the upcoming year.
Making Informed Decisions
Making informed decisions during the medical aid review period involves a thorough understanding of your health needs and may also include other insurance products like medical insurance and gap cover policies. These review periods offer individuals the opportunity to see if their current policy/policies meet their needs. It is also important to note that a medical aid and medical insurance are different.
A medical aid provides a wider range of cover compared to insurance, including benefits for in-hospital procedures and treatment, and they are designed with various care programmes to assist with things including, but not limited to, chronic maintenance, maternity, and preventative care. Medical insurance on the other hand offers cover on more specific things such as cover for day-to-day benefits like GP visits and acute medication, but they also ensure that you have hospital cover in the case of an accident or an emergency.
Start by reviewing the information provided by your medical scheme and the updates from MedXpert. Evaluate whether your current plan meets your health requirements, considering factors such as maternity benefits, chronic condition cover, and co-payment structures. Use the insights gained from your advisor consultations to compare different health plans. Assess the benefits and costs of each option, keeping in mind your anticipated medical needs for the upcoming year. Make sure to consider any changes in the Designated Service Provider (DSP) list to ensure continuity of care with your preferred healthcare providers.
Top changes from Medical Schemes for 2025
MedXpert brings you the latest insights and updates on medical schemes. Bookmark this page and keep it on hand, as we will continuously update it with the most recent changes and developments during this medical scheme premium and benefit review period. Our goal is to ensure you stay informed about the top medical scheme changes as they happen, so you can make the best decisions for your health cover. Whether you’re looking to compare plans, understand new benefits, or stay on top of medical scheme updates, you’ll find everything you need right here. Check back regularly to stay ahead and make the most informed choices for your medical aid needs.
Discovery Health Medical Scheme
For 2025, Discovery Health Medical Scheme has announced substantial changes, with an average weighted contribution increase of 9.3% across its range of plans.
Discovery is also introducing the Active Smart plan, specifically designed for young professionals, starting at R1,350 per month.
In light of the success of the WELLTH fund in 2023 and 2024, Discovery has opted to tailor this benefit so that members can obtain a more personalised benefit offering. The WELLTH fund can now be recognised as the new and improved Personal Health Fund. In connection with the Personal Health Fund, new joining members will received an added, once in a life time benefit.
While these changes may be overwhelming to know how they may impact you as a Discovery Health member, at MedXpert we pride ourselves at being the experts and being your trusted source of knowledge and information.
Bonitas Medical Fund
For 2025, Bonitas Medical Fund has announced an average weighted contribution increase of 10.2%, with variations across their plans.
Bonitas 2025 Care Programmes have been enhanced to offer more comprehensive support across various health areas. Members can access consultations for managing conditions like diabetes and hypertension, as well as free programmes promoting healthy living, such as weight management (subject to specific plans). They have also strengthened their maternity and childcare offerings, providing support from early pregnancy through childhood, with benefits such as early detection, proactive care, and mental health assessments.
For older members, they have introduced a geriatric programme, which offers wellness and preventative care services at home for members above the age of 70 years. The introduction of this programme is to ensure that members receive ongoing health support for all stages of life.
With these changes, it can be difficult to know how your cover can be impacted. At MedXpert, we are here to help. Let us guide you through these updates and assist you in finding the right plan that suits your needs and budget.
Genesis Medical Scheme
The 2025 Genesis Medical Scheme plans see an average weighted increase of 5.4% across their plans, with specific increases for principal members, adult, and child dependents.
Key benefit enhancements for MED-100, MED-200, and MED-200 Plus plans include increased allowances for dental procedures, consultations, and medical treatments like haemodialysis and cancer care. These changes aim to provide more comprehensive support, with notable increases in cover limits for various services, ensuring better value and healthcare benefits for members.
Sizwe Hosmed Medical Scheme
The 2025 Sizwe Hosmed Medical Scheme plans bring an average premium increase of 13.73% across their various plans, with different adjustments depending on the plan type.
Key enhancements include a 5% overall increase in benefits, with optical benefits seeing an 8% boost. Additionally, Medical Savings Accounts (MSA) have been introduced to plans like Value Platinum, Value Platinum Core, and Titanium Executive, providing extra flexibility for out-of-hospital expenses.
The Medical aid Savings Account (MSA) offers 22.7% of contributions for out-of-hospital benefits on Value Platinum and 20.8% for Titanium Executive, ensuring more comprehensive cover for services such as optical and conservative dentistry. Members’ MSAs will be allocated quarterly, helping them manage their health expenses more effectively throughout the year.
Medihelp Medical Scheme
The 2025 Medihelp Medical Scheme plans see an average premium increase of 10.8% across all plans, along with several key adjustments to enhance member benefits.
The MedElect plan has seen a significant 77% increase in day-to-day benefits per member, and the MedSaver plan now offers R2,500 per family for GP, specialist visits, and medication, expanding beyond the previous coverage for children to include the entire family. Additionally, all benefit limits and co-payments have been adjusted in line with inflation, providing better support for members’ healthcare needs.
Momentum Medical Scheme
The 2025 Momentum Medical Scheme plan updates reflect an average premium increase of 9.4% across the different options, with specific increases ranging from 8.8% to 9.8% depending on the plan.
Key updates include the restructuring of the Ingwe Option, introducing the Ingwe Connect network, which offers members a more cost-effective healthcare solution. Benefit limits and co-payments across all plans have also been adjusted in line with inflation to ensure continued value for members. Additionally, Momentum Health4Me continues to grow, with increased benefit limits and a modest premium adjustment.
Bestmed Medical Scheme
For 2025, Bestmed has introduced a 12.75% contribution increase across all options, accompanied by enhancements designed to improve support and care for members.
Among the key updates are increased benefit limits and expanded preventative care cover, which now include mammograms and pap smears across all 14 plan options.
Additionally, the child dependent age has been raised to 24 years, eliminating the need for proof of studies.
Other notable improvements include extended benefits for specific procedures, enhanced diagnostic imaging limits, and a set allowance for take-home and over-the-counter medication available on various plans.
FedHealth Medical Scheme
FedHealth has announced a 12.4% average contribution increase across plans for 2025, alongside targeted adjustments like an 18% premium reduction for the myFED option. This reduction aligns with FedHealth’s commitment to accessibility, simplifying the plan structure by consolidating six income bands into four while maintaining benefits.
Key enhancements include a new partnership with Sanlam, offering complementary Gap cover solutions across all plans. Members also gain access to retinopathy screening for neonates on FlexiFED 1, 2, 3 and 4 plans, AI retinal screening for diabetic members over 12, and an annual Weight Management Programme with expanded GP and pathology benefits.
Further updates include increased Flexible Savings limits, optional Flexible Savings features, and new chronic Designated Service Providers for select plans. Women living with HIV can now access an HPV PCR test every three years, and take-home medication allowances have been increased to R400 per admission across all plans.
KeyHealth Medical Scheme
For 2025, KeyHealth has implemented an 11.9% average contribution increase, introducing new features aimed at enhancing primary and preventative care.
Notable updates include the KeyHealth Rewards Programme, which encourages members to undergo preventative screenings, and new digital tools like the Digital Health Assessment and expanded virtual consultations via Clicks Udok, making healthcare resources more accessible.
KeyHealth has also prioritised care for high-risk members by introducing a Cardiac Monitoring Programme and the Geri-Care Programme for members over 65. These programs provide regular health check-ins, medication support, and continuity of care through new In-hospital and Post-discharge Care Programmes.
To encourage cost-effective day procedures, in-room procedure tariffs have been enhanced across Silver, Gold, and Platinum plans. Members can also access proactive health tools via the Member App Health Booster.
Medshield Medical Scheme
Medshield has announced a 9.6% average contribution increase for 2025, accompanied by several enhancements focused on proactive and comprehensive health management.
One of the standout features is the new Specialist Network, covering 15 key specialties like cardiology, orthopaedics, and ophthalmology, ensuring members have access to high-quality care. Additionally, emergency room fees for up to two visits per family annually are now covered, and co-payments have been reduced or removed for treatments like oncology medications.
The MediSwift option will be discontinued from January 2025, with members being defaulted to either MediPhila or MediValue. Medshield has communicated this change to the relevant members, ensuring they have the opportunity to either accept their default option or select a different option that better suits their needs. Expanded support for preventative care includes enhanced maternity benefits and improved clinical pathways for chronic and acute conditions.
Profmed Medical aid
Profmed introduces an 8.4% average contribution increase for 2025, along with exciting benefit enhancements. These include expanded maternity benefits through the Tums2Tots Baby and Toddler Programme, which offers expecting parents digital support and a curated baby bag or voucher.
The AMPLIFIRE benefit is another standout feature, providing an extra R2,500 for GP, specialist visits, dentistry, and supplementary services—unlocked by completing proactive health steps. Oncology benefits have also seen a significant boost, with up to R400,000 per beneficiary now covered on select options.
To further support members, specialist consultation tariffs for dermatologists, gynaecologists, neurologists, and paediatricians will increase by 10%.