Bianca Visagie - Healthcare Specialist

23/11/2025

Brokers + Gap Cover = A Winning Team

With rising healthcare costs and medical aid limitations, brokers play a vital role in protecting clients from unexpected medical expenses.

By partnering with trusted Gap Cover providers, brokers can:
✅ Bridge the financial gap for clients
✅ Add real value to their service
✅ Stand out in a competitive market

𝘛𝘶𝘳𝘯𝘣𝘦𝘳𝘳𝘺 𝘔𝘢𝘯𝘢𝘨𝘦𝘮𝘦𝘯𝘵 𝘙𝘪𝘴𝘬 𝘚𝘰𝘭𝘶𝘵𝘪𝘰𝘯𝘴 (𝘗𝘵𝘺) 𝘓𝘵𝘥 𝘪𝘴 𝘢𝘯 𝘢𝘶𝘵𝘩𝘰𝘳𝘪𝘴𝘦𝘥 𝘍𝘪𝘯𝘢𝘯𝘤𝘪𝘢𝘭 𝘚𝘦𝘳𝘷𝘪𝘤𝘦𝘴 𝘗𝘳𝘰𝘷𝘪𝘥𝘦𝘳 (𝘍𝘚𝘗 𝘯𝘰. 36571). 𝘜𝘯𝘥𝘦𝘳𝘸𝘳𝘪𝘵𝘵𝘦𝘯 𝘣𝘺 𝘓𝘰𝘮𝘣𝘢𝘳𝘥 𝘐𝘯𝘴𝘶𝘳𝘢𝘯𝘤𝘦 𝘊𝘰𝘮𝘱𝘢𝘯𝘺, 𝘢𝘯 𝘈𝘶𝘵𝘩𝘰𝘳𝘪𝘴𝘦𝘥 𝘍𝘪𝘯𝘢𝘯𝘤𝘪𝘢𝘭 𝘚𝘦𝘳𝘷𝘪𝘤𝘦𝘴 𝘗𝘳𝘰𝘷𝘪𝘥𝘦𝘳 (𝘍𝘚𝘗 1596) 𝘢𝘯𝘥 𝘐𝘯𝘴𝘶𝘳𝘦𝘳 𝘤𝘰𝘯𝘥𝘶𝘤𝘵𝘪𝘯𝘨 𝘯𝘰𝘯-𝘭𝘪𝘧𝘦 𝘪𝘯𝘴𝘶𝘳𝘢𝘯𝘤𝘦 𝘣𝘶𝘴𝘪𝘯𝘦𝘴𝘴. #𝘛𝘶𝘳𝘯𝘣𝘦𝘳𝘳𝘺𝘎𝘢𝘱𝘊𝘰𝘷𝘦𝘳 #𝘎𝘢𝘱𝘊𝘰𝘷𝘦𝘳 #𝘕𝘢𝘷𝘪𝘨𝘢𝘵𝘪𝘯𝘨𝘵𝘩𝘦𝘞𝘢𝘺 #𝘔𝘦𝘥𝘪𝘤𝘢𝘭𝘌𝘹𝘱𝘦𝘯𝘴𝘦𝘴 #𝘔𝘦𝘥𝘪𝘤𝘢𝘭𝘌𝘹𝘱𝘦𝘯𝘴𝘦𝘚𝘩𝘰𝘳𝘵𝘧𝘢𝘭𝘭

23/11/2025

23/11/2025

Financially stable medical schemes are built on strong reserves, which ensure claims are paid and help schemes manage economic pressures or pandemics.

Learn more about what this means for your cover as you weigh your options this open season: https://bit.ly/3X7WTcm

23/11/2025

Brought to by Lee Callakoppen

Bonitas makes Top500 list for third consecutive year.
The awards celebrate organisations that combine strategic vision with operational efficiency.

Bonitas has a member-first ethos and continues to strengthen its reputation for reliability and excellence. Bonitas has a member-first ethos and continues to strengthen its reputation for reliability and excellence.

Bonitas Medical Fund has been named among South Africa’s Top500 Best Managed Companies for the third year running, reaffirming its commitment to strong governance, effective management and prioritising the best interests of its members.

The Top500 Awards celebrate South African organisations that demonstrate excellence in management, governance and sustainable performance.

They recognise companies that successfully combine strategic vision with operational efficiency. Bonitas’s inclusion on the list underscores its consistent focus on delivering high-quality healthcare solutions across the country.

Lee Callakoppen, principal officer of Bonitas, says: “Being recognised by Top500 for the third year is a clear endorsement of our approach to governance and management. Our focus remains on operating responsibly while maintaining transparency and ensuring that the needs of our members guide every decision.

“This recognition reflects the dedication of our team to provide affordable, quality healthcare for all South Africans.”

Bonitas continues to strengthen its reputation for reliability and excellence, proving that a quality offering, good governance and a member-first ethos can drive both organisational success and a positive impact on the healthcare sector.

19/11/2025

Planning your Private Healthcare Funding for 2026

Looking ahead to 2026, Martin Rimmer — CEO of Sirago Underwriting Managers — shares these key tips:

Planning your private healthcare funding for 2026
South Africans are facing another tough year of rising medical scheme costs in 2026. Weighted average premium increases range between 6% and 9%, depending on the benefit option – despite the Council for Medical Schemes (CMS) recommending that increases be limited to CPI (3.3%) plus reasonable utilisation.¹

Across the country’s leading open medical schemes, the announced increases are: Discovery (7.2%), Bonitas (8.8%), Medihelp (8.46%),and Bestmed (6.8%).¹ While these increases are marginally lower than 2025, the combined effect of electricity hikes, fuel inflation, and rising food costs means that household budgets are stretched to breaking point.

“For many households, the cost of medical scheme membership consumes a significant portion of monthly disposable income – yet it remains a non-negotiable given the state of the public healthcare system,” says Martin Rimmer, CEO of Sirago Underwriting Managers. “Even for those with employer subsidies, affordability has become a growing challenge as both employees and employers face tightening economic conditions.”

Paying More for Less: The Reality of Medical Inflation

Medical scheme contributions rise each year, driven by higher claims costs, increased utilisation, and an ageing membership base. As a result, members are paying more but receiving less cover, facing escalating co-payments, penalties, sub-limits, and out-of-pocket expenses.

“Medical schemes simply cannot keep pace with the rate of medical inflation while keeping premiums affordable,” Rimmer explains. “The result is continual benefit erosion and an increase in member exposure to self-funding.”

Gap Cover Claims Reveal the True Cost Pressure

Sirago’s five-year analysis of gap insurance claims (2021–2025) reveals a sharp rise in claim values – a clear indicator of both benefit erosion and the buy-down trend toward more affordable, “core” hospital plans.

Gap cover protects members from the shortfall between what specialists charge and what medical schemes pay for in-hospital procedures. Specialists often bill 300% to 500% above the agreed medical scheme tariffs, leaving members liable for the difference – often tens of thousands of rands.

“A few years ago, the average mega gap claim was between R6,000 and R12,000,” says Rimmer. “Today, we’re seeing daily mega claims exceeding R50,000 – a symptom of affordability pressures and widening gaps between medical scheme tariffs and provider fees.”

The rise in high-value claims underscores the need for members to review their cover carefully and understand the implications of buying down to lower-cost options. While these options reduce monthly premiums, they also come with limited benefits, stricter rules, and more penalties for non-compliance – significantly increasing the risk of out-of-pocket costs if no gap cover policy is in place.

Planning Your Healthcare Funding Strategy for 2026

In 2026, with premium increases outpacing inflation, healthcare funding requires strategic planning, informed choices, and professional guidance. Balancing affordability with adequate cover is more critical than ever to safeguard your health, your family, and your financial wellbeing. This balance is best achieved with the advice and direction from a professional, accredited and independent financial advisor.

Medical scheme members have until the end of November 2025 to make benefit option changes to be effective 1 January 2026. Sirago advises members to work closely with their financial advisor to assess their personal needs, compare relevant options, and craft a sustainable healthcare funding solution.

Here are key considerations when reviewing your cover for 2026:

1. Maintain Your Medical Scheme Membership: Don’t delay joining a medical scheme or rely on enrolling later in life. Late joiner penalties and waiting periods apply – including a three-month general and 12-month condition-specific waiting period if you’ve had a break in cover.

2. Analyse Your Day-to-Day Spending: Review how much you’ve spent out-of-pocket versus what your medical scheme covered. Overspending or underutilising benefits may mean you’re on the wrong option.

3. Consider Chronic Conditions: If you or a dependant have a chronic illness, ensure that it’s registered with the scheme and covered under the Prescribed Minimum Benefits (PMBs) list as well as the prescribed medication is part of the schemes medicine formulary.

4. Evaluate whether savings from a cheaper option justify the potential loss of chronic benefit access.
Know How Much You Can Self-Fund: Lower premiums mean fewer benefits. Be realistic about what you can afford to self-fund and consider setting up a dedicated medical savings card/account for routine care and medication.

5. Get Gap Cover: Gap cover bridges shortfalls for in-hospital procedures – a critical safety net as specialists often charges far above medical aid rates. Without it, members risk facing shortfalls of R50,000 to R200,000 or more.

6. Understand Core Plans: Hospital or “core” plans only cover in-hospital events. Members must self-fund all GP visits, medication, dentistry, and optometry. Consider pairing such a plan with a complementary health insurance product that provides primary care benefits.

7. Stay Within the Same Scheme if Possible: If you’re changing options, try stay within your current scheme to avoid waiting periods. Most allow a “buy-down” any time during the year, but “buy-ups” are generally only permitted at the start of a benefit year.

8. Beware of Waiting Periods: Waiting periods and late-joiner penalties can apply even when switching between schemes. Professional guidance is essential to avoid being caught off guard.


“Healthcare in South Africa is complex, and the consequences of poor planning can be financially devastating. Always work with an accredited, experienced healthcare advisor who can explain your benefits, exclusions, and options – and help you put the right mix of medical scheme and gap cover in place to protect your health and your finances,” concludes Rimmer

Contact me for free advice on your medical aid and Gap Cover. Let me help you make an informed, confident decision.
📞 082309 7012

16/11/2025

💡 Planning your private healthcare funding for 2026 has never been more important.

Medical scheme premiums are set to rise between 6% and 9% next year - well above inflation - as households grapple with higher food, fuel, and electricity costs.

As Martin Rimmer, CEO of Sirago Underwriting Managers, explains: “Members are paying more but receiving less cover, facing escalating co-payments, penalties and out-of-pocket expenses.”

If you haven’t reviewed your healthcare plan for 2026, now is the time.

✅ Check your benefits

✅ Review your gap cover

✅ Speak to a professional financial advisor

@ 082 309 7012

Protect your health - and your wallet - with informed planning.
Read our latest article on what you need to know… https://www.sirago.co.za/planning-your-private-healthcare-funding-for-2026/



14/11/2025

BESTMED guilty…of making wellness effortless.

09/11/2025

Bonitas Hospital Network


Bonitas Medical Fund is one of South Africa’s premier medical aid schemes, renowned for its commitment to providing extensive health coverage to its members.

Bonitas’ hospital network plans are designed to ensure that members have access to high-quality medical care through an extensive network of hospitals across the country. By partnering with leading hospitals, Bonitas ensures that its members receive specialized treatment and state-of-the-art facilities at more affordable rates.

The hospital network plans typically include a variety of features such as comprehensive hospital cover, emergency medical services, and major medical benefits, which cover severe illnesses and surgeries. Bonitas also provides additional options for maternity and chronic disease management, emphasizing their focus on comprehensive healthcare solutions.

What is a medical scheme hospital network?

A medical scheme hospital network refers to a specific selection of hospitals and healthcare facilities that have agreements with a particular medical aid provider or health fund to offer services at negotiated rates. This arrangement is part of what many health plans offer to manage costs and ensure quality care for their members.


Negotiated Rates
Medical schemes negotiate rates with hospitals within their network to keep healthcare costs lower for both the scheme and its members. These agreed-upon rates usually mean that members will face fewer out-of-pocket expenses when they use network hospitals.

Defined Access
Members of a medical scheme that uses a hospital network are usually required to seek care only at hospitals within the network to benefit from full coverage. If members choose to go outside the network, they might have to pay a larger portion of the bill themselves, or in some cases, all of it.

Streamlined Administration
The relationship between network hospitals and the medical scheme allows for more streamlined administrative processes. This can include faster pre-authorisation for procedures, simpler billing procedures, and generally less paperwork for patients to handle.

Emergency Exceptions
Most hospital network plans provide exceptions for emergencies, allowing members to seek immediate care at the nearest hospital, even if it’s not part of the network, with the costs usually covered under the emergency care terms of the plan.

When to Choose Network Plans

Opting for a hospital network plan from a medical aid scheme can be a strategic and financially wise choice under several circumstances.

These plans are particularly beneficial for individuals or families looking to balance cost-effective healthcare coverage with access to quality medical services.

When Cost is a Major Consideration

Hospital network plans are typically more cost-effective than broader coverage options because they involve care provided at a select group of hospitals where the medical scheme has negotiated favourable rates. This can significantly reduce premiums and other out-of-pocket expenses, making these plans an ideal choice for individuals, families, or employers seeking to manage healthcare costs without sacrificing the quality of care.

When Quality and Accessibility are Prioritized

Hospital network plans are designed to provide care from a network of accredited hospitals known for maintaining certain quality standards. This ensures that while the pool of facilities may be more limited, the quality of care is reliable.

For Those with Predictable Healthcare Needs

Individuals and families with predictable healthcare needs, including routine checkups, planned surgeries, or ongoing treatments for chronic conditions, can benefit greatly from hospital network plans.

For Young, Healthy Individuals

Young and generally healthy individuals who require minimal medical services can find hospital network plans especially suitable. These plans often provide essential coverages at a lower cost, which matches the lower health risk and less frequent need for medical services of younger people.

When Comprehensive Benefits are Needed for Chronic Conditions

Some hospital network plans are tailored to offer extensive coverage for chronic conditions, including necessary medications, treatments, and regular consultations. For individuals managing long-term health conditions, these plans ensure that they have access to affordable and continuous care.

Bonitas Network Hospitals


The list of Bonitas hospital networks can be accessed through the following steps:

✅ Visit the Bonitas website and click on “Networks”
✅ Log in to the Member Zone, click on Healthcare and then on Locate a provider
✅ Log in to the Bonitas Member App and tap on Find a provider
✅ By simply selecting your plan, the type of provider you are looking for, and your location, you will be able to search for a provider near you.

Bonitas Network Plans

Bonitas Medical Fund offers a range of medical aid plans that are network-bound, catering to different needs and preferences. Here’s a brief look at some of the plans that are linked to specific networks:

BonCap
This plan is tailored for lower-income earners and involves specific network hospitals and providers to help manage costs effectively.

Primary Select and Standard Select

These are traditional plans not linked to a savings and offer day to day + dentistry*** + optometry + Benefit Booster

BonEssential and BonEssential Select
These hospital plans offer essential cover at network hospitals, making healthcare more affordable.

Hospital Standard
As the name suggests, this plan provides coverage in network hospitals for a variety of treatments and conditions.

Network Hospital Exceptions


Bonitas Medical Fund allows members to visit non-network hospitals under specific conditions, particularly in emergency situations or when there are capacity issues within their designated network hospitals.

In general, if a member requires emergency medical attention and the nearest network hospital cannot provide the necessary care or is too far away, Bonitas may permit treatment at a non-network hospital. However, it’s important to note that these instances may be subject to co-payments or other conditions depending on the specific terms of the member’s plan.

Conclusion

Choosing a hospital network plan from Bonitas offers a balanced approach to managing healthcare needs and expenses. Pros of these plans include reduced premiums and overall healthcare costs due to negotiated rates with network hospitals. However, the cons involve restricted choices; members must receive care within the network to avoid higher out-of-pocket costs, which can be limiting if preferred hospitals or specialists are outside the network.

While hospital network plans from Bonitas offer significant advantages in terms of cost and quality, the limitations in provider choice and flexibility should be carefully considered to ensure they align with personal or family healthcare needs and preferences.

01/11/2025

🌿 Nutrition for an Expecting Mom 🤰

Pregnancy isn’t just about eating for two — it’s about nourishing for two! 💛 The right nutrients support your baby’s growth and keep you feeling energised and strong.

Here’s what to focus on:

🥦 1. Iron & Protein
Help build your baby’s tissues and prevent fatigue.
→ Add lean meats, lentils, spinach, eggs, and beans.

🍓 2. Folate (Folic Acid)
Essential for your baby’s brain and spinal development.
→ Enjoy leafy greens, citrus fruits, avocado, and fortified grains.

🥛 3. Calcium & Vitamin D
For strong bones and teeth.
→ Include milk, yoghurt, cheese, almonds, and time in the sunshine.

🍠 4. Complex Carbs & Fibre
Keep your energy steady and digestion smooth.
→ Think oats, quinoa, brown rice, and plenty of fruits and veggies.

💧 5. Hydration
Your body needs extra fluids for amniotic fluid, blood volume, and milk production.
→ Aim for 8–10 glasses of water a day, plus herbal teas or infused water.

⚖️ Tip: Listen to your body — gentle, balanced meals are better than heavy ones. And always check supplements with your healthcare provider.

✨ You’re growing life — that’s incredible. Nourish yourself with love, rest, and mindful choices.

01/11/2025

Industry body warns Treasury that ending R29bn in annual tax relief could strip thousands of cover before state system is ready

01/11/2025

How medical aid shortfalls affect your financial future
GAP COVER IS NO LONGER A LUXURY IT'S. A NECESSITY

By Tony Singleton - Chief executive of Turnberry Gap Cover

MEDICAL costs are rising rapidly, and medical inflation is outstripping the ability of medical aid schemes to keep up, even with annual premium increases..

YOU plan for retirement, save for your child’s education, and try to build a financial cushion, but what happens when medical co-payments chip away at those plans, year after year?

It starts small: A R5 000 co-payment for a scope. Then, a few months later, a R12 000 shortfall for a hospital admission. Fast forward five years, and you’ve spent tens of thousands on out-of-pocket medical costs that your medical aid didn’t fully cover.

Medical aids cannot keep pace with the rate of medical inflation while still maintaining affordable premiums, so co-payments grow each year, more sub-limits are introduced, and specialist fees continue to outpace medical aid rates.

This means more and more South Africans are finding themselves forced to draw from their retirement funds or take on debt to cover medical aid shortfalls. Medical aid alone is no longer enough to protect your financial future — gap cover has become essential.

Medical scheme members, especially those on higher-end plans, often assume they are covered for any medical eventuality — until it is time to actually claim for a significant medical event. Even comprehensive plans can fall short when it comes to specialist charges, hospital procedures, or newer, high-tech treatments.

Many specialists charge as much as five or six times the scheme rate, and certain procedures have limits to what medical aid will pay or require an up-front co-payment. While your medical aid might pay a portion, the remainder becomes your responsibility.

This can become a compounding problem. What starts as a few isolated bills adds up. Over time, shortfalls from surgeries, diagnostics, scopes, chronic illness treatment, or specialist consultations can add up to hundreds of thousands of rand.

For example, one Turnberry client managing spinal conditions, lupus, and gastro-oesophageal reflux disease (GERD) claimed R478 000 across 27 incidents in only five years. Another has claimed R450 000 across 54 incidents related to lung disease and spinal conditions, and a third, with multiple chronic issues, has received over R448 000 in gap cover payments over the same period.

As the years go by, these amounts continue to add up, and this is becoming an increasingly typical pattern. Many families are forced to pause investments, take out loans, or remove money from their retirement annuities to keep up with these uncovered and unanticipated expenses.

Gap cover was created precisely to tackle these medical expense shortfalls, with an affordable policy that sits alongside medical aid and offers cover for medical expense shortfalls, co-payments, sub-limit cover, oncology shortfalls, prosthesis costs, and even casualty visits. Where medical aid benefits have tightened to control premiums, gap cover has expanded to fill the void.

Many South Africans still believe gap cover is a nice-to-have or something that is only necessary later in life. The reality, though, is that shortfalls affect people no matter what age they are, from broken bones in their 20s to maternity bills in their 30s or chronic conditions emerging in their 40s and beyond.

Joining early also makes a difference, as you are covered from the start and your premiums will remain lower than someone beginning their cover at 65, when age-based premium increases and health exclusions may apply.

Gap cover is not just for major surgeries or cancer treatments; it is valuable for more routine procedures as well as accidents and emergencies. And its value increases over time, especially if you remain continuously covered and avoid reintroducing waiting periods.

By staying on gap cover year after year, members build a stable financial buffer against the cumulative effect of medical costs. We’ve seen clients rely on gap cover for decades of health events, not just one-off emergencies, and the value of continuous cover is evident in our lifetime claims figures.

Gap cover is no longer a luxury; it is an essential tool for building long-term financial resilience. Without it, medical aid shortfalls can easily undo years of careful financial planning. Talk to your broker about finding the best gap cover solution to fit your needs.