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Lead Source

Why getting advice from a broker matters

Choosing a medical aid or gap cover product is not only about finding the lowest monthly premium. It is about understanding what will happen when you need to use your cover.

In South Africa, the private medical scheme environment is large and complex. The Council for Medical Schemes regulated 71 medical schemes, serving more than 9.1 million beneficiaries, through 33 administrators, 43 managed care organisations and over 10,000 brokers and brokerages in the 2024/25 financial year.

That is a lot for any individual or family to compare alone.

At Universal Cover, we believe good advice should give clients confidence, not confusion. A broker helps you understand the detail behind the brochure, including:

What your medical aid really covers
Which hospitals and doctors are in-network
What co-payments may apply
Which chronic benefits are included
Whether your savings account will be enough
Where gap cover can protect you from shortfalls
How your cover should change as your life changes

A broker can also help after you have joined. The CMS says brokers assist with applications, benefit queries, claims, scheme rules, wellness benefits and chronic care programmes.

How broker commission works

Many people think using a broker will cost them more. In most cases, it does not.

For medical schemes, broker commission is regulated under the Medical Schemes Act. From 1 January 2026, the maximum broker fee a medical scheme may pay is the lesser of:

R125.86 plus VAT per month, or
3% plus VAT of the member’s monthly contribution

This fee covers both the introduction of the member and ongoing advice or service. The CMS also confirms that members do not pay anything extra for a broker’s assistance unless they have agreed in writing to additional services.

For gap cover and other insurance products, commission is also normally paid by the insurer and must be disclosed as part of the advice process. Insurance disclosure rules require details of commission or intermediary remuneration to be made available to policyholders.

Why this matters

Using a broker gives you access to professional guidance at no additional direct cost. That means you can ask questions, compare options and make better decisions before you commit.

Healthcare decisions affect your family, your finances and your peace of mind. You should not have to make them alone.

With Universal Cover, you get more than a quote. You get advice, support and someone on your side when it matters.