What to Expect from 2026 Medical Scheme Contribution Increase

South Africans enrolled in medical schemes should prepare for another year of notable premium adjustments in 2026.

The Council for Medical Schemes (CMS) has issued guidance recommending that contribution increases remain modest around 3.3%, and up to 6.8% when factoring in higher benefit utilisation. While this offers a useful benchmark, it may not reflect the full picture across the industry.

Based on market trends and actuarial insights, the ASI Employee Benefits team anticipates that actual increases could exceed these figures, with some schemes potentially approaching double-digit adjustments. Several factors are contributing to this upward pressure:

· An ageing member base, which increases overall risk

· Elevated claims utilisation, particularly in post-pandemic care patterns

· Slower growth in younger entrants, limiting the ability to balance the risk pool

These dynamics are already affecting affordability. Over the past two years, our financial planning engagements have highlighted the growing strain on employees trying to keep pace with rising healthcare costs.

What this means for employers

Planning ahead is more important than ever. Employers should prepare for above-average increases and take a strategic approach to managing healthcare benefits. Key considerations include:

· Reviewing plan design to ensure affordability without sacrificing value

· Understanding the diverse financial needs of employees

· Exploring long-term funding models that support sustainability and access to care

While some organisations may consider shifting to restricted-benefit options or alternative solutions, it’s essential to evaluate these choices carefully. Without thoughtful planning, such changes may fall short of employee expectations and could lead to unintended consequences like reduced engagement or productivity.

Navigating the road ahead

Scenario-based budgeting and a refreshed total rewards strategy are no longer optional they’re essential. Employers must adopt a forward-thinking mindset to manage rising healthcare costs while continuing to support the wellbeing of their workforce.

At ASI, our independent advisors use data-driven insights to help employers design medical benefits that balance cost and value. With the right strategy, it’s possible to navigate this evolving landscape and make informed decisions that benefit both the organisation and its people.