Bigger, older, and more concentrated: 7 facts reshaping medical schemes
Twenty years of industry data show that medical schemes have become increasingly dependent on scale, investment returns, and strong reserves to remain sustainable.
#CouncilforMedicalSchemes
Medscheme rejects Bonitas’s explanation for post-transition disruptions
Medscheme says it repeatedly warned Bonitas against a ‘clean-cut’ transition and disputes the scheme’s claim that unresolved legacy issues were behind the service disruptions experienced by members after the administration switch.
Bonitas members caught in service disruption after administration switch
The medical scheme says legacy issues contributed to post-transition challenges as members report delays with hospital authorisations and medication approvals.
Bonitas: administrator change is part of a wider repositioning
The scheme says continuity of care remains the priority as it moves administration to Momentum Health and managed care to PHA on 1 June.
3Sixty wins lifeline in accreditation dispute with CMS
The High Court finds the Council must disclose the material it relies on before taking a decision that affects the provider’s ability to operate.
Medscheme secures Sisonke administration mandate
The appointment strengthens Medscheme’s foothold in the employer-based healthcare sector.
Parliament flags slow progress on Health Market Inquiry reforms
The CMS cites statutory constraints, while the Portfolio Committee on Health calls for a clear roadmap to implement the Inquiry’s recommendations.
CMS moves to rein in how medical schemes investigate fraud
Circular 10 introduces interim rules to standardise audits, investigations, and clawbacks as broader reforms are developed.
Bonitas-Medscheme court battle stalls as application removed from urgent roll
Medscheme’s bid to halt Bonitas’ administration transition has been delayed after procedural lapses and unresolved interlocutory issues forced the matter off the urgent roll.
Tensions rise as Bonitas and Medscheme clash ahead of court showdown
Bonitas, Medscheme, and PHA trade accusations as court papers, whistleblower claims, and a CMS probe intensify the battle over medical scheme contracts.
Sizwe Hosmed: High Court blocks board comeback, new curator installed
The CMS frames the judgment as necessary to protect members, emphasising the scheme is compliant, operational and under close oversight.
Bonitas-Medscheme split: what the CMS probe means for members
The scheme and the regulator say a narrowly focused investigation will not halt the transition – but members should brace for some operational changes.
Bonitas’ dispute with Medscheme heads to court
Bonitas’ decision to change administrators comes amid a CMS investigation and High Court proceedings involving its former service provider.
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.
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.
