One source, one year
Every figure comes from the CMS Industry Report 2024, published by the Council for Medical Schemes. Using the same report and year for every scheme means they are compared fairly. Each figure on the page shows its page number.
Check 1: Safety cushion (solvency ratio)
Money the scheme has saved to keep paying claims in a bad year, measured against what members pay in a year.
The law requires at least 25% (3 months). The average open scheme holds 33.36% (4 months) (CMS, p. 149).
| Below 25% | Below the legal minimum | 0 points |
| 25% to under 33.36% | Meets the legal minimum, below average | 1 point |
| 33.36% or more | Above average | 2 points |
Check 2: Pressure to raise prices (relevant healthcare expenditure ratio)
Of every R100 members pay, how much goes straight back out in claims. The rest has to cover running the scheme.
Running a scheme costs about R6.89 of every R100 (CMS, p. 151). So above R93.11, claims and running costs add up to more than members pay in. The average open scheme pays out R91.91 (CMS, p. 91).
| R91.91 or less | Low: money coming in covers claims and costs | 2 points |
| Above R91.91 up to R93.11 | Some: little room to spare | 1 point |
| Above R93.11 | High: paying out more than it takes in, so price increases or benefit cuts are likely | 0 points |
The score
Score = 1 + safety cushion points + pressure-to-raise-prices points, giving a whole number from 1 to 5. A scheme is only rated when both checks have a sourced figure. We never give partial scores or re-weight around missing figures.
What the score means
| 5/5 | Above-average safety cushion, and money coming in covers claims and costs. |
|---|---|
| 4/5 | Strong on one check, middle on the other. |
| 3/5 | Strong on one check, weak on the other, or middle on both. |
| 2/5 | Middle on one check, weak on the other. |
| 1/5 | Weak on both: below the legal minimum and paying out more than it takes in. |
The score uses the regulator's 2024 figures for every scheme, so all schemes are judged the same way.
Shown for context, not scored
Since then: newer figures, such as unaudited results in the regulator's later annual report, appear as a "Since then" note. They don't change the score, because other schemes' figures for that period aren't comparable yet.
Next year's increase: the average increase a scheme has announced, next to the regulator's guideline (3.8% for 2027, CMS Circular 20 of 2026).
Regulator action: sourced notes about investigations or directives.
What we don't use
Complaints are not used, because the regulator does not publish them per scheme. Member reviews and sentiment are kept separate and never affect the score.
When it's updated
We refresh the check when the next CMS Industry Report is published, expected December 2026.
This is information, not financial advice.