This dissertation intends to shed light on open-membership medical scheme benefit
design in South Africa. This will be done by analysing the benefit design of 118 benefit
options, so as to provide an overview of the structure and nature of the benefit
offerings available in the market in 2014. In addition, affordability of these benefit
options was analysed in order to identify whether or not there exist connections
between the benefits on offer and the price of cover. This paper will argue that
at present, the large number of benefit options available in the market, the lack
of standardisation between benefit options, together with the mosaic of confusing
terminology employed in scheme brochures, creates a highly complex environment
that hampers consumer decision making. However, this implicit complexity was
found to be necessary owing to the incomplete regulatory environment surrounding
medical schemes. The findings of this investigation show that benefit design requires
significant attention in order to facilitate equitable access to cover in South
Africa.