Small business health insurance in South Africa is either a registered medical scheme, regulated by the Council for Medical Schemes, or a health insurance product, which is insurance that pays fixed benefits. They are different products. Some providers set a minimum group size: for example, Momentum Health4Me needs 5 or more employees, each aged 18 or older and earning under R40,000 a month.
Get the product type confirmed in writing before you sign anything, and confirm group requirements with the scheme or insurer directly. See the Council for Medical Schemes comparison and finance and funding requirements.
Eligibility Requirements at a Glance
- Group size: there is no single minimum. Momentum Health4Me requires 5 or more employees; other schemes and insurers set their own rules. Ask each provider.
- Employee eligibility: for Momentum Health4Me, each employee must be 18 or older and earn under R40,000 a month. Another source showed R30,000, so confirm the current limit with Momentum.
- Which scheme can you join: any person can join an open scheme, while employer closed schemes are tied to employers or professions.
- Regulation: medical schemes fall under the Medical Schemes Act (No. 131 of 1998). Health insurance is overseen under the Insurance Act (No. 18 of 2017).
Income and Affordability Requirements
Medical schemes. Contributions for the same plan can vary only by income and number of dependants. Schemes must cover prescribed minimum benefits: emergencies, 271 listed conditions and 25 chronic conditions. A registered medical scheme cannot reject an application (Council for Medical Schemes explains).
Health insurance. It usually pays only if specific health-related events happen, as a fixed amount or lump sum. Premiums are risk-rated and can rise with age, and a hospitalisation policy may not cover medical expenses. It must not be presented as a replacement for scheme membership.
Rates. No premium or rate figures were verified for this page. Ask the scheme, insurer or an authorised broker for a written quote for your group, including dependant rates and any administration fees.
Credit and Financial Requirements
Providers may ask for company documents and payroll details. Confirm exactly what they need before you apply.
- Waiting periods: schemes may impose a general waiting period of up to three months and a condition-specific waiting period of up to 12 months. Exceptions apply for prescribed minimum benefits.
- Tax: check the tax treatment of employer contributions with SARS or a registered tax practitioner before setting up the arrangement.
- Payroll deductions from wages need to follow employment law, so get advice before deducting contributions.
Documents and Verification Required
Requirements differ by provider. For Momentum Health4Me, the employer submits a company application form and a membership template by email to [email protected]. For other providers, ask for their group application checklist.
- Company registration documents (such as CIPC records)
- A list of employees with identity numbers, ages and dependants
- Payroll and contribution details
- Details of any existing cover being replaced
Ask the provider which of these it needs; the list above is general and not an official checklist.
How to Apply and Improve Approval Readiness
- Decide whether you want a registered medical scheme or a health insurance product, and tell staff in writing which one it is.
- Ask an authorised broker, or the scheme or insurer directly, about group minimums and employee limits.
- Check the product against the Council for Medical Schemes guidance on schemes versus insurance.
- Get the full cost structure and waiting periods in writing before you commit.
- Ask what happens to an employee’s cover when they leave.
Frequently Asked Questions
What is the difference between a medical scheme and health insurance?
A registered medical scheme must cover prescribed minimum benefits and cannot reject an application. Health insurance pays a fixed amount or lump sum on specified events and is not required to cover prescribed minimum benefits.
What are small business health insurance plans?
Options include a registered medical scheme or a health insurance product. Momentum Health4Me is one employer-group product, for 5 or more employees. Confirm the current terms with Momentum.
What does small business health insurance cover?
A medical scheme must cover prescribed minimum benefits. A health insurance product need not, and usually pays only when specific health-related events happen. Read the product terms to see what is covered.
What are small business health insurance rates?
Scheme contributions for the same plan vary only by income and dependants. Health insurance premiums are risk-rated and can rise with age. We have not published figures, so request a quote.
How do I check a provider?
Ask whether the product is a medical scheme or a health insurance product, and check that with the Council for Medical Schemes (schemes) or the regulator of insurers. Do not offer staff anything you cannot verify.
Are employer contributions taxable?
Confirm the tax treatment with SARS or a registered tax practitioner.
What happens when an employee leaves?
This depends on the product. Ask the provider about continuation options and any waiting periods for joining individually.
Confirm group requirements with the Council for Medical Schemes, your chosen scheme or insurer, and SARS for tax. See the finance and funding requirements hub and compare loan requirements.