A closed medical aid scheme, also called a restricted medical scheme, is a medical aid scheme that is only open to certain groups of individuals rather than to the general public. These groups of people could include employees from a company, or members of a particular industry. The scheme is then not allowed to exclude anyone within that group.
Closed medical schemes are required to follow the same rules as open schemes, which are governed by the Medical Schemes Act of 1998.
As of the end of 2019, South Africa housed 80 different medical aid schemes, of which 59 were restricted or closed medical schemes, with just over 4 million members and 8.87 million beneficiaries. This ratio of closed to open medical schemes has been steadily decreasing over the last two decades.
Restricted or closed medical schemes are typically much smaller in membership numbers than open schemes. For example, the largest restricted scheme in South Africa is the Government Employees Medical Scheme (GEMS) which has just under 700 000 members and around 1.8 million beneficiaries. The South African Police Service Medical Scheme (Polmed), the second largest closed medical aid, has just over 175 000 members and over 500 000 beneficiaries. Compare this to Discovery Health, South Africa's largest open medical aid scheme, which has around 1.3 million members and 2.3 million beneficiaries.
One of the biggest advantages of a closed medical scheme is that because only certain individuals are included, risk exposure can be better managed and collective bargaining power means that membership costs are reduced. As well as this, the benefits can be specifically designed around the needs of that group of individuals – such as policemen who may be subjected to higher risks as a result of the nature of their work.
DISCLAIMER: The information on this website is for educational purposes only, and is not intended as medical advice, diagnosis or treatment. If you are experiencing symptoms or need health advice, please consult a healthcare professional.