Medihelp Medical Scheme will appeal the Pretoria High Court judgment delivered last week by Judge Jan Swanepoel, which found the scheme in contempt of an earlier court order concerning the treatment of six-year-old Zachary de Wet.
The contempt application was brought by the De Wet family and Rare Diseases South Africa, who argued that Medihelp had not complied with the order handed down by Judge Anthony Millar on 26 August 2022 regarding funding for Elaprase and related treatment costs.
In his 31 October ruling, Judge Swanepoel ordered Medihelp to purge the contempt by complying fully with the Millar order, except for the cost of Elaprase, which will be determined by the Appeal Board of the Council for Medical Schemes (CMS).
In a media statement, Medihelp said the judgment finds that it should not fund the cost of Elaprase – the central issue in earlier court proceedings.
“Notwithstanding this significant finding, the court in this matter holds Medihelp in contempt of a prior judgment, the interpretation of which itself is currently the subject of an appeal,” the scheme said.
Medihelp confirmed that it does not agree with the judgment and, on the advice of its legal counsel, will appeal against it.
“The order, however, provides that Medihelp need not fund the cost of Elaprase, which is in accordance with the findings of the Council for Medical Schemes, as well as its Appeals Committee. These findings also held that Medihelp is not obliged to cover the cost of Elaprase.”
Varsha Vala, principal officer at Medihelp, said the scheme’s decisions are based on fairness, clinical evidence, and sustainability.
“As the custodian of the funds of all of its members, Medihelp is obligated to provide all members with access to quality healthcare in accordance with the Medical Schemes Act and Prescribed Minimum Benefits framework,” she said. “We recognise how difficult these circumstances are for the families involved, but we must balance compassion with our duty to act responsibly and prudently on behalf of all our members.”
Medihelp added that it continues to “extend compassion to the De Wet family” and to pay those claims it is lawfully obliged to fund.
The case background
The case centres on the treatment of Zachary de Wet, who has Hunter’s Syndrome (MPS II) – a rare, incurable genetic disorder that can be managed with the enzyme replacement therapy Elaprase.
Zachary was prescribed Elaprase in July 2021. Medihelp did not approve funding for the treatment, stating that it did not qualify as a Prescribed Minimum Benefit (PMB) and was not available in the public health sector as required by the Medical Schemes Act.
After Zachary’s condition worsened, his mother, Michaney de Wet, brought an urgent application before the High Court. On 26 August 2022, Judge Millar ruled that Hunter’s Syndrome was a PMB condition under category 901K of the regulations and ordered Medihelp to fund the prescribed treatment, including Elaprase, pending the outcome of a related complaint to the CMS.
The CMS and appeal process
In December 2022, the Registrar of the CMS determined that Elaprase did not qualify as PMB-level care because, although available in the public sector, it was not funded by the state except through a compassionate access programme. According to Judge Swanepoel’s judgment, Medihelp then ceased funding Elaprase, taking the view that the Millar order had lapsed.
Zachary’s mother returned to court and obtained an order confirming that the Millar judgment remained in effect until the full CMS process was completed. Medihelp appealed that ruling, arguing that the appeal suspended the order.
Meanwhile, Rare Diseases South Africa assisted the family in securing interim funding so that Zachary could continue receiving Elaprase treatment.
On 30 June 2025, the CMS Appeal Committee found that Hunter’s Syndrome is a PMB condition and that Elaprase can constitute PMB-level care, but it upheld the Registrar’s decision on the basis of Medihelp’s solvency levels – concluding that the scheme was not obliged to fund the drug given its financial position.
Medihelp has appealed that finding to the CMS Appeal Board, specifically challenging the solvency ruling, while the De Wet family and Rare Diseases SA have also appealed aspects of the decision. The NGO has committed to funding Elaprase for Zachary until the CMS Appeal Board issues its final determination.
Medihelp’s solvency ratio declined to 20.99% by the end of 2024, remaining below the statutory minimum of 25% set by the Medical Schemes Act. The drop follows a 10-point decrease in 2023. To address the shortfall, Medihelp submitted a three-year recovery plan to the CMS, which was approved and includes targeted contribution increases to rebuild reserves.
The scheme’s drop in solvency ratio stems partly from its 2021 decision to forgo contribution increases during the Covid-19 pandemic. When Moonstone reported on Medihelp’s solvency ratio in June this year, Medihelp Board chairperson Chris Klopper said the move aimed to support members during severe economic hardship, while Vala emphasised that the current solvency position is a “temporary and actively managed deviation” backed by a focused recovery strategy.
This is NOT what was noted in the judgement and is factually incorrect!