CMS says GEMS cannot cut 25% reserve requirement
The comment comes amid a growing standoff between organised labour and GEMS after the scheme announced a 9.8% contribution increase for 2026.
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Appeals Board ruling puts Centriq–Dis-Chem partnership on the line
In Circular 48, the CMS signals tougher enforcement against exempted insurers, warning that non-compliant branding and failure to notify regulators will attract decisive action.
MediCheck claims win as Discovery Health writes off up to R170m in ATB recoveries
Discovery Health has abandoned recovery action against more than 16 500 members, agreeing to absorb up to R170 million in overpaid ATB claims after sustained pressure from MediCheck,
CMS steps in as Discovery Health begins recovering pharmacy overpayments
Discovery Health is engaging affected members individually after a processing error led to some pharmacy claims being paid beyond Above Threshold Benefit limits during 2025.
‘Medical schemes face structural strain as claims growth outpaces contributions’
The 2024 Industry Report highlights rising utilisation, ageing membership, and persistent under-pricing as the key forces reshaping medical scheme sustainability.
Eleven schemes account for nearly 90% of broker fees
Broker service fees made up 17.65% of medical schemes’ directly attributable insurance service expenditure in 2024.
Sizwe Hosmed making substantial progress, says curator
An accelerated 19% contribution increase is designed to correct historic under-pricing and shore up reserves.
Bonitas commits to co-operating with CMS investigation
After concluding its section 43 inquiry into Bonitas, the CMS has determined that the allegations merit a further forensic investigation.
Medihelp to appeal contempt judgment in Elaprase case
Medihelp says it will challenge the judgment while the cost of Elaprase awaits a final decision by the CMS Appeal Board.
CMS: No complaints about brokers’ conduct in 2024/25
The Council for Medical Schemes’ latest annual report shows a decline in registered complaints – continuing a three-year downward trajectory.
Consumer Goods Medical Scheme launches new options as it opens to entire sector
The Council for Medical Schemes has approved two savings plans that will be marketed from 1 November.
CMS research points to urgent need for chronic disease and cost-of-care reforms
Two new CMS studies highlight the growing strain of chronic diseases and soaring out-of-pocket healthcare costs.
High Court confirms curatorship of medical scheme
The Court ordered Sizwe Hosmed’s principal officer to personally pay legal costs after dismissing the scheme’s attempt to overturn the provisional curatorship.
Discovery delays 2026 contribution increase to April
Leading open medical schemes have announced increases above the CMS’s guidance, underscoring the tension between regulator calls for restraint and schemes’ funding needs.
Provisional curator to advise on future of medical scheme
The curator will assess Sizwe Hosmed’s finances and recommend whether it should merge, be liquidated, or continue.
Medical scheme hikes: CMS calls for restraint, but will schemes listen?
The Council for Medical Schemes recommends capping 2026 contribution increases at 3.3% plus “reasonable utilisation estimates”, yet past trends show schemes often push far higher.
Panel upholds findings of racial bias in medical scheme fraud investigations
Statistical analysis found that black healthcare professionals were multiple times more likely than their white peers to be investigated and found guilty of FWA.
