Discovery members ‘make the Smart move’, while KeyCare loses ground
The decline in KeyCare Plus membership reflects a reduction in employer subsidies and fewer mandates for medical scheme membership, DHMS says.
claims
Consumers adjusting insurance covers to cope with rising cost of living
Santam says clients are opting for core covers only, part-insuring assets, increasing excesses, and taking risk-mitigation measures to reduce premiums.
Old Mutual’s risk benefit payouts rise by 4.3% to R14.7bn
The ‘big four’ illnesses made up 73% of severe illness claims; cancer alone accounted for 68%, driven by breast and prostate cancers.
Crime, fire, and weather remain key drivers of commercial claims
Theft under property covers remains the leading driver of crime-related claims, even as overall crime claims dipped in 2024, Santam reports.
Non-life complaints resolved in favour of policyholders at 16.5%
Lead Ombud Edite Teixeira-Mckinon warns against drawing hasty conclusions about complaints stats without factoring in claims volumes and policy counts.
Non-life insurance ombud sees 11% drop in complaints in 2024
Most complaints to the NFO went to the Non-life Division, whose interventions yielded R107m in quantifiable benefits for policyholders.
NFO’s Life Division recovers over R202m for consumers in 2024
Complaints about life-benefit payouts climbed to 36% of the Division’s cases, from 34% in 2023.
RAF loses another medical scheme member liability case
The High Court, endorsing the minority judgment’s view, rules the Fund must pay the medical expenses covered by Discovery Health.
Liberty flags high income protection claims in the financial sector
The group also notes a surge in capital disability benefit claims, driven by increases in the number of claimants and the average sum assured.
Medical expenses | Court grants leave to appeal in member’s dispute with RAF
The outcome of Discovery Health’s appeal before the SCA will affect the outcome of the member’s claim for R1.4 million.
Suicide-related life claims surge by 62% over five years
Discovery Life’s claims data reveals rising risks, with increasing concerns about mental health and skin cancer.
Court orders RAF to pay medical scheme members’ claims
Another attempt by the Road Accident Fund to contest liability based on the ‘majority decision’ against Discovery Health has fallen through.
Majority judgment ‘does not alter’ RAF’s liability for medical scheme members’ claims
The High Court in Cape Town rejects the Road Accident Fund’s contention that the Mlambo judgment has altered the legal landscape.
Alexforbes reports R7 billion in two-pot system withdrawals
It says 47% of members intend to make future claims – with 34% of those who have already claimed planning to do so again.
Discovery vs RAF: CMS executive says High Court got it wrong
A regulatory expert believes the judgment misinterpreted key legal principles in its ruling on the RAF’s obligation to reimburse medical schemes.
Discovery to appeal ‘far-reaching’ judgment in favour of RAF
The High Court says Discovery Health misconstrued the scope of the judgment that set aside the RAF’s first directive on the payment of medical scheme members’ claims.
How the dispute between the RAF and Discovery unfolded
Discovery Health’s quest for reimbursement from the RAF for medical expenses incurred by road accident victims has faced multiple legal hurdles, with new RAF directives complicating the situation.
