Trevor Schoonraad, Health Manager at Axiomatic Consultants

 

As a healthcare broker for the last 25 years, I’ve seen firsthand how overwhelming and confusing South Africa’s healthcare system can be for both employers and employees. There are several medical schemes, vastly different benefit structures, and confusing terms such as PMB’s, waiting periods and late joiner penalties to name a few. The possible introduction of the National Health Insurance (NHI) simply adds to the complexity. Given this it has never been more critical to have a trusted advisor in your corner.

 

Our role as brokers is simple: we help businesses and employees make informed decisions about their medical cover, ensuring they get the best value and access to quality healthcare.

 

Why Employers Need a Broker

 

1. Managing Healthcare Costs Without Compromising on Quality

 

Medical scheme and health insurance premiums increase every year with medical inflation – which is always higher than headline inflation. The average 2025 benefit year increases were between 9.3% and 12.75%, making it harder for businesses to provide comprehensive healthcare benefits while keeping costs under control. As brokers, we analyse different providers, compare pricing, and negotiate the best possible solutions for the employer and their employees.

 

2. Customised Healthcare Solutions for Employees

 

Every company has unique healthcare needs based on its workforce demographics. A young, healthy team might need different benefits than an older workforce. We work closely with employers to design tailored solutions that provide suitable and cost-effective cover for employees.

 

3. Ensuring Compliance with Changing Regulations

 

Medical schemes are heavily regulated in South Africa, and with the NHI on the horizon, the rules are constantly evolving. We stay up to date with all regulatory changes and ensure employers are informed of such changes.

 

4. Supporting Employees with Claims and Queries

 

One of the biggest frustrations employees face, is dealing with medical scheme claims and understanding their benefits. Instead of having HR departments bogged down with medical aid queries, we step in to assist employees directly—whether it’s assisting with claims, resolving disputes, or clarifying benefits.

 

5.  Enhancing Employee Well-being and Retention

 

A strong healthcare benefit offering improves employee satisfaction and retention. When employees feel secure about their health cover, they are more engaged at work. We ensure they understand their benefits, make full use of them, and promote long-term health.

 

Why Employees Benefit from a Broker

 

Many people believe they can navigate medical aid plans on their own—but with over 20 different medical schemes and hundreds of plans to choose from, it’s easy to make the wrong choice. Here’s how we help individual employees:

 

1. Helping You Choose the Right Medical Scheme

 

We take the time to understand your personal healthcare needs—whether you’re single, supporting a family, or managing chronic conditions. Based on this, we recommend the best plan at the most affordable price.

 

2. Maximising Your Benefits

 

Many members don’t use all the benefits available to them simply because they don’t know they exist. We ensure you fully understand what your plan covers, helping you save money and get the most value from your medical aid.

 

3. Assisting with Claims and Disputes

 

Medical claims can be confusing and frustrating. If a claim is rejected or delayed, we step in to sort it out for you—saving you time, stress, and unexpected out-of-pocket expenses.

 

4. Helping You Access Additional Health Programs

 

Some medical schemes offer wellness programs, chronic disease management, or reward benefits—but not everyone knows how to access them. We guide you through these extra benefits, ensuring you get the full support available to you.

 

What About Broker Fees?

 

Many people ask, “If I use a broker, do I pay extra?” The answer is no.

 

Broker commissions are built into your medical scheme premium whether you use a broker or not. According to the Council for Medical Schemes (CMS), the broker is entitled to a maximum of 3% of your monthly contribution, capped at R121.84 (plus VAT) per month per member.

 

If you don’t use a broker, this money does not reduce your premium—it simply stays with the medical scheme. So, why not take advantage of expert advice and get the expert advice and support you’re already paying for?

 

The Impact of the NHI on Private Healthcare and Medical Schemes

 

The National Health Insurance (NHI) Bill has raised concerns for businesses and employees alike. While the government aims to provide universal healthcare, there are many uncertainties about how it will affect private medical schemes and employer-provided healthcare benefits. Importantly, legal challenges to the NHI Act have already begun, which could delay its full implementation. Until these legal processes conclude, it remains unclear how private healthcare and NHI will function together.

 

1. Will Medical Schemes Still Exist?

 

Under the proposed NHI framework, private medical schemes may only be allowed to cover services not included in the NHI package. This means many current plans could change dramatically, and employees may have fewer options than they do today.

 

However, with legal opposition already underway, the future of private medical schemes remains uncertain. Until the legal process is resolved, these changes cannot be considered final, and private medical schemes will continue to operate as they do today.

 

2. What Happens to Employer-Subsidised Healthcare Benefits?

 

Many companies currently offer healthcare subsidies as a key employee benefit. If NHI is fully implemented, employers may need to rethink their healthcare strategy—potentially shifting to top-up cover products instead.

 

3. Will NHI Be Affordable and Efficient?

 

There are concerns about how the NHI will be funded and whether it will be able to provide the same level of quality healthcare that private schemes currently offer. Employees may still prefer private healthcare for faster access, specialist care, and quality treatment—even if NHI becomes a reality.

 

​The financial feasibility of NHI remains a significant concern, with cost estimates varying widely and the 2025 national budget lacking explicit funding allocations for the initiative. Given South Africa’s current fiscal constraints, it is difficult to see how NHI will be financed in the near future. For now, the medical aid tax credit (which helps reduce the cost of private healthcare for taxpayers) remains in place, signalling that the government is not yet ready to dismantle medical schemes.

 

4. The Role of Brokers in an NHI System

 

Even under NHI, brokers will still play an essential role in guiding individuals and businesses through their healthcare options. We will assist with understanding the new system, finding additional cover where necessary, and ensuring members still receive high-quality healthcare.

 

Why Having a Broker Matters More Than Ever

 

With medical costs rising, regulations changing, and NHI looming, employers and employees need expert guidance to navigate South Africa’s complex healthcare environment.

 

As brokers, we offer:

 

• Unbiased advice to help you choose the best plan
• Support with claims, disputes, and queries
• Cost-effective strategies for employers and employees
• Compliance guidance to keep businesses protected
• A personal touch, because healthcare is about people, not policies

 

The bottom line? You don’t need to navigate healthcare alone. Whether you’re a business looking to provide the best benefits to your employees or an individual needing medical cover that truly works for you, having a broker ensures you get the most out of your healthcare investment.

 

ENDS