The role of accredited brokers in the medical schemes environment

Understanding what you are paying for is key to making the most of your medical scheme membership. Every month, a small portion of your medical scheme contribution goes toward broker fees, which is a regulated component of your premium designed to give you access to professional advice.

Following our recent information on how to choose a medical scheme or benefit option, the Council for Medical Schemes (CMS) would like to help you better understand the role of brokers and their services. Brokers can help you compare medical scheme options, assist with completing membership applications, and manage claims or benefit queries, but using one is not compulsory. As a member, you may choose to engage a broker for additional support or manage your medical scheme membership directly.

All brokers are accredited by the CMS and are paid on a monthly basis through your medical scheme, which helps maintain fairness, transparency, and consistency across the industry.

Whether you are a new member or a long-time contributor, you do not pay anything extra for a broker's assistance unless you have agreed in writing to additional services.

Broker services

Brokers provide valuable support throughout your membership journey, including:

• Expert advice on choosing a medical scheme and benefit option that suits your health needs and budget.
• Application assistance when joining a scheme or changing options.
• Ongoing service with claims, benefit queries, and understanding scheme rules.
• Benefit guidance to help you make the most of additional offerings such as wellness and chronic care programmes.

By offering these services, brokers act as your trusted representative, ensuring you understand your benefits and get the best value from your medical scheme.

Broker fees

The commission paid to brokers is regulated by the CMS under the Medical Schemes Act

(131 of 1998). From 1 January 2025, the maximum broker fee a medical scheme may pay is the lesser of:

• R121.84 plus VAT per member, per month, or
• 3% plus VAT of your total monthly contribution.

This payment covers both the introduction or admission of new members to a medical scheme and ongoing support in respect of benefits or services offered by a medical scheme.

Learn more about broker fees in Circular 2 of 2025, which focuses on the adjustment of fees payable to brokers.

Accreditation of brokers

Only brokers accredited by the CMS may provide healthcare broker services. This accreditation ensures that brokers meet strict professional standards and act in the best interests of members. Medical schemes are not permitted to compensate any broker who is not accredited.

View the list of accredited brokers and other regulated entities on the CMS website to confirm that your broker is authorised to offer services.

Brokers are regulated under Section 65 and Regulation 28 of the Medical Scheme Act (131 of 1998).  To better understand the regulations that govern brokers and protect you as a member, download the Medical Schemes Act here.

*This published by the Council for Medical Schemes.