The official ending of the 43-year-long relationship between Medscheme and Bonitas Medical Fund on Monday, when Momentum Health stepped in as the new administrator of the fund, has been marked by bottlenecks and frustration from members, reports BusinessTech.
The biggest transfer ever of a medical scheme from one provider to another – which has added 750 000 beneficiaries to Momentum’s administration – has swelled its market share from 22% to 30%.
But for many of the hundreds of thousands of Bonitas members, it has been a week of upheaval and frustration, reports News24, with scores of angry and frustrated beneficiaries taking to social media to vent their emotions.
While Momentum has acknowledged the issues, and accepted responsibility, it said it had been “aware that the transition was going to post challenges”, and was working to resolve the issues urgently.
One complainant, Esthernita Ukena, had said despite her matter being escalated, after 10 calls to Bonitas, “all of them were dropped by agents after waiting 45 minutes to get authorisation. Had to postpone [the] operation due to your transition…”
On Monday, Waseemah Gabriels reported that there was no support to be had: “None of the agents responds; we have been waiting for five hours in the queue.”
Will Bendix of Durban, who contacted News24 on Tuesday, said he was due to undergo an ear operation at Entabeni Hospital on Wednesday, but after nine days of trying, he had yet to get pre-authorisation.
Eventually, he went to the pre-admissions department of the hospital to see if they could get through and book the procedure, he said. “But the hospital staff told me they were having the same problem and were sitting on a backlog of claims and authorisations for Bonitas members.”
Momentum Health’s chief marketing officer Damian McHugh said although it had anticipated glitches, “we are using the opportunity to learn, resolve the issues as soon as possible, and improve processes to avoid the same bottlenecks going forward”.
“We are also aware that members requiring urgent pre-authorisations for medical procedures have experienced extended wait times and contact centre delays that fall short of our standard 24- to 48-hour turnaround.
“We take full responsibility for our part in resolving this.”
McHugh said while Momentum Health managed member contact, enquiries and claims processing, clinical authorisation decisions rested with its clinical partner, Private Health Administrators (PHA).
“Both organisations recognise that the transition volume has created a bottleneck in the authorisation workflow, and we are working jointly to resolve this,” he said.
Several urgent cases with time-critical scheduled procedures – including that of Bendix and Ukena – have already been resolved, McHugh said.
“Our teams are committed to addressing these issues with urgency, taking swift, decisive action and maintaining transparent communication with all stakeholders. We are confident these interventions will significantly improve service delivery in the short term.”
Court case pending
In November 2025, Medscheme launched an urgent high court application seeking to halt the Bonitas tender process, alleging governance and procurement irregularities.
The administrator argued that the tender process was not fair or transparent.
The Council for Medical Schemes said at the time that initial findings warranted further investigation and launched a Section 44 probe – a regulatory intervention triggered when serious governance, procurement and fiduciary failures are suspected.
The court case was originally set down in the Johannesburg High Court for 3 March this year, but was removed from the roll by agreement. It is now due to be heard next week.
The court file includes an affidavit made by Medscheme director Gerald van Wyk in mid-December, in which he warned that when the new contracts went live – when Momentum Health took over as the administrator of Bonitas – the damage would be irreversible.
“It entails the transfer of administration, managed care functions, data systems, provider arrangements, authorisation protocols, payment flows and regulatory reporting obligations,” he said.
“Once these processes are live, unwinding them would be operationally complex, costly, disruptive to members and providers, and likely to prejudice third parties who are not before the court.
“Once the new contracts are implemented, the prejudice to Bonitas and its members flowing from a fatally flawed procurement process becomes irreversible.”
PHA, which runs Bonitas’ lower-cost benefit option, Boncap, will continue to work with the scheme, having done so since 2020.
Aligned with realities
Bonitas had said its latest operational transition is aimed at ensuring its operating model aligns with changing realities in the healthcare market.
“This is not change for the sake of change. Healthcare needs are evolving, consumer expectations are changing, and the pressures facing South Africans are intensifying,” said Principal Officer Lee Callakoppen.
“To remain relevant and continue delivering value, healthcare organisations need to become more agile, responsive and better equipped to meet the demands of a rapidly evolving environment.”
He added that the performance of Bonitas in the past 18 months had exceeded all previous benchmarks, with more than 80 000 new families successfully enrolled on the scheme and financial sustainability stronger than previous years.
See more from MedicalBrief archives:
Momentum to spend millions, hire hundreds, for Bonitas takeover
Bonitas-Medscheme row threatens jobs – Sanlam CEO
Medscheme launches urgent bid to pause Bonitas move