Platinum Health Medical Scheme announces increased benefits for 2026

Platinum Health Medical Scheme has announced a significant new benefit for members in 2026. By converting the Overall Annual Limit into a dedicated Hospital Annual Limit, the Scheme has unlocked a remarkable 36% increase in benefits. 

Platinum Health CEO Rodney Gounden explains that the overall annual limit on PlatFreedom currently applies to all plan costs, including benefits with sub-limits. “This means that when members use benefits with sub-limits, those costs count toward both the sub-limit and the overall annual limit, effectively depleting the overall limit more quickly. But, from 2026, the overall annual limit will primarily apply to in-hospital benefits, and sub-limit benefits will no longer impact the overall annual limit. This change is expected to extend members’ benefits by approximately 36%.”

Platinum Health Medical Scheme is also expanding coverage and introducing new vaccines (pneumococcal for adults and RSV) to ensure members have access to the best possible healthcare. Gounden says: “These preventive measures represent strategic investments in member health. Pneumococcal disease poses serious risks to adults, particularly those with chronic conditions or compromised immunity. By covering adult pneumococcal vaccines, we’re preventing potentially severe complications, hospitalisations and long-term health impacts. Similarly, RSV vaccines for pregnant women protect newborns during their most vulnerable period, reducing lower respiratory tract disease in infants. These additions reflect our commitment to proactive, preventive healthcare that improves outcomes while managing long-term costs through early intervention.”

In addition, Platinum Health is opening new pharmacies and upgrading clinical services across its network, making it easier for members to access quality care closer to home.

Ongoing digital innovation

Digital transformation is at the heart of Platinum Health’s service improvements. Among the digital innovations is its WhatsApp platform, which now allows members to check benefits, submit claims, access membership cards and receive real-time updates.

In 2026, Platinum Health will be adding more features, including access to welcome packs, feedback surveys, member detail updates, authorisation requests and chronic medicine ordering – all within WhatsApp.

The introduction of a new queue management system at clinics will allocate a digital queue number to members when they arrive at a facility. They can then track waiting times in real-time and will get SMS notifications when it’s almost their turn. This reduces waiting frustration, improves satisfaction and helps clinics manage staff and consultation rooms more efficiently.

Contributions below market average

The new benefits were highlighted as Platinum Health announced contributions for 2026.

Contributions will go up by 7.0%, which Gounden notes is still below the market average. 

He says: “Healthcare costs are rising across the board because healthcare services and medicines are becoming more expensive, the population is ageing, and more people are using medical services since the COVID-19 pandemic. Despite these pressures, Platinum Health remains financially sound with strong reserves, an improved loss ratio and a stable membership base.”

“Many other medical schemes are implementing much higher increases, but our strong financial management and efficient claims control have kept costs under control. Since 2020, our total increases have remained well below industry trends – proving our commitment to value and affordability. As we move into 2026, we continue to focus on affordability, innovation, and better healthcare access for our members,” he says.

Gounden emphasises that Platinum Health remains committed to quality healthcare, stability and innovation. “Despite economic challenges and rising healthcare costs nationwide, we continue to offer affordable, high-quality access to healthcare and a seamless member experience,” he concludes.