Medical aids in South Africa currently typically classify these treatments as ‘elective’ care.

A pilot programme that pays for surgery and hormone replacement therapy for transgender patients has been available to those on the Executive and Comprehensive plans since 2018. Image: Moneyweb

A motion to review access to healthcare for transgender and gender diverse members has been narrowly approved at the Discovery Health Medical Scheme (DHMS) AGM.

The resolution received votes of 52% in favour of the motion, with 30.29% against it and 17.71% of those who attended abstaining.

Read: 2026 medical aid contribution increases: DHMS vs the rest

DHMS’s rules govern how written proposals should be submitted to the scheme as well as how these are considered by its board.

It says all motions received by its principal officer were reviewed and one motion (this one) was put to this year’s meeting.

According to the motion, at a minimum, this review should include:

• The adequacy, fairness and transparency of current benefit design and funding criteria applicable to healthcare for transgender and gender diverse members, including hormone therapy and gender-affirming surgical interventions;
• Whether current Scheme rules, clinical criteria, managed care protocols and decision-making processes are enabling or impeding fair access to clinically appropriate healthcare;
• Whether current approaches are informed by current clinical evidence, recognised standards of care and relevant international and South African clinical guidance, and are consistent with the Scheme’s stated constitutional and human-rights values; and
• Whether members are provided with sufficiently clear, accessible and transparent information to understand applicable criteria, available benefits, review processes and appeal mechanisms.

The motion requests that the review “be guided by relevant clinical evidence and by South Africa’s constitutional values of equality, dignity, privacy and access to healthcare, and should include meaningful engagement with affected members and appropriately qualified clinical, legal and human-rights experts with relevant expertise in human-rights-centred transgender and gender diverse healthcare.”

The board of DHMS must report back to members on the review’s findings as well as any recommendations arising from it.

Pilot programme

According to the South African Journal on Human Rights, Discovery Health began a pilot programme in 2018 which pays for surgery as well as hormone replacement therapy (HRT) for transgender patients.

It says to date Discovery “has approved care for two of the five patients who applied to take part in the programme”.

One report from 2021 says Discovery’s cover under this programme remains “limited” and references a “lifetime limit” (at that time) of “R200 000 in partial payment benefits”.

The pilot programme is only available to members on the Executive and Comprehensive plans.

Present landscape

The author of the January 2026 paper, Sophy Baird, surveyed six of the country’s largest medical schemes and found that the Government Employees Medical Scheme (Gems), Fedhealth and Profmed all “require members on HRT to pay for chronic medication from their medical savings, and once that is exhausted, from their own pockets”.

Under the Medical Schemes Act, all schemes have to cover the cost related to the diagnosis, treatment and care of an emergency medical condition, a defined list of 271 diagnoses, and a defined list of 27 chronic conditions, as prescribed minimum benefits (PMB). This includes lifelong conditions such as asthma, diabetes or hypertension.

Read: Youth opting out of medical aid signals affordability crisis

Currently, medical aids in South Africa typically classify HRT as non-PMB or “elective” care.

The Medical Schemes Amendment Bill (the draft of which was published in 2018) proposes scrapping PMBs in favour of a more comprehensive package of conditions and services to be included in cover.

Other resolutions that passed

The three other resolutions voted on at the AGM were passed with votes in favour of more than 75%.

These were for the approval of trustee remuneration (75.72%), a non-binding vote on remuneration policy (75.14%) and the appointment of Deloitte as auditors for 2026 (94.83%).

Read: Trio of medical aids fail to maintain required liquidity

DHMS did not disclose how many members voted, but at the start of the AGM, board chair Michelle Norton confirmed that 91 principal members were logged onto the meeting (which was more than the requirement of 50 for quorum).

The scheme had 1.368 million principal members as at 31 December 2025.