After the Bell: Millions belong to medical aids, but few care about governance issues

My email inbox is exploding. Not just my work email, but my personal mailbox that I started as a freelancer back in 2013. 

That’s right folks, I have 143,657 emails dating back to 2013 – it was a point of pride that I didn’t delete important emails… 

As you can imagine, I am running out of space and now desperately trying to delete redundant mails. (How did I end up subscribing to so many newsletters? I mean, aside from the Daily Maverick newsletters, what else do you really need?)

And so, like you (be honest), I may sometimes be guilty of glossing over certain emails – like the ones notifying me about the annual general meeting for my medical scheme - and my right to vote. 

About 8.9 million people belong to just more than 70 medical schemes currently, according to the Council for Medical Schemes. I looked at the three biggest medical schemes – Discovery Health, Momentum medical scheme and Bonitas. 

The Discovery Health medical scheme has 2.8 million members and Bonitas has around 731,576 beneficiaries.

So, you have to wonder how it is that none of them publicly publishes how many members attend their AGMs – whether online or in-person? For all three, public minutes/notices do not state attendance head counts or proxy totals. Only quorum confirmations and the proxy process are on record. This, surely, seems like under-reporting?

For context, Medshield (while admittedly a smaller scheme) had about 136,903 beneficiaries for 2023 and reported– wait for it – 37 members “in attendance via the virtual platform” forming a quorum at its 2024 AGM.

Given that most medical scheme members complain about the cost of membership, (the biggest debit order on my bank account), it seems mind boggling that we don’t take a greater interest in these AGMs - they are, after all, the mechanism by which trustees are voted in each year. 

The requirements to be a trustee are basic at best – you need to be an individual who is a member of the scheme, with integrity, skills and competence. You cannot be a trustee if you have been or are: 

• Declared insolvent / bankrupt and not rehabilitated;
• Convicted of fraud, theft, corruption, forgery or perjury (unless a pardon or 10+ years have passed since sentence was completed);
• Of unsound mind (as declared by a court);
• Removed as a trustee, director or equivalent for misconduct by a court or regulator; or
• An employee, auditor, administrator or broker of the scheme (to avoid conflicts of interest).

Well, that seems simple enough. OK, so you have a three-year term typically and the number of actual trustees is fairly low, considering the size of the schemes - Discovery Health and Momentum medical schemes currently have seven trustees each while Bonitas has eight trustees. 

And now, dear reader, hear comes the kicker.

The total combined remuneration for all Discovery Health medical scheme trustees in 2024 was R12.6-million. Momentum medical scheme publicly discloses policy and governance but not the rand amounts paid to trustees, which presumably is shared directly with members (please do reach out and share this information if you are a member). 

Bonitas lists trustees “remuneration and other disbursements” at R8.1-million. 

These are rather large sums of money – and you’re paying them. 

Kind of makes attendance at that AGM a little more pressing, no? DM