Data released by Sirago Underwriting Managers “paints a stark picture of the escalating risk transfer from medical schemes to their members.” - Daily Maverick (6 Nov 2025)
The data shows that out-of-pocket gap claims have “exploded” by 512% between 2020 and 2024. Claims exceeding R50,000 have “skyrocketed in both volume and value” implicating that the average large loss gap claim increased from R6,000 to R12,000 to R63,000.
“According to Martin Rimmer, CEO of Sirago, schemes are ‘constrained by affordability, access, [and] ageing membership populations’ and are choosing to ‘systematically reduce benefits and transfer more risk onto the member’ rather than impose premium hikes that match healthcare inflation.
“Medical inflation has been rising much faster than the consumer price index (CPI), meaning procedure costs are outpacing salary increases.
“According to Brian Harris, director of operations at Turnberry Management Risk Solutions, a major driver is the gap between what schemes pay and what specialists charge: up to 500% of the medical scheme rate.”