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,
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.
The 2024 Industry Report highlights rising utilisation, ageing membership, and persistent under-pricing as the key forces reshaping medical scheme sustainability.
Broker service fees made up 17.65% of medical schemes’ directly attributable insurance service expenditure in 2024.
An accelerated 19% contribution increase is designed to correct historic under-pricing and shore up reserves.
After concluding its section 43 inquiry into Bonitas, the CMS has determined that the allegations merit a further forensic investigation.
Medihelp says it will challenge the judgment while the cost of Elaprase awaits a final decision by the CMS Appeal Board.
The Council for Medical Schemes’ latest annual report shows a decline in registered complaints – continuing a three-year downward trajectory.
The Council for Medical Schemes has approved two savings plans that will be marketed from 1 November.
Two new CMS studies highlight the growing strain of chronic diseases and soaring out-of-pocket healthcare costs.
The Court ordered Sizwe Hosmed’s principal officer to personally pay legal costs after dismissing the scheme’s attempt to overturn the provisional curatorship.
Leading open medical schemes have announced increases above the CMS’s guidance, underscoring the tension between regulator calls for restraint and schemes’ funding needs.
The curator will assess Sizwe Hosmed’s finances and recommend whether it should merge, be liquidated, or continue.
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.
Statistical analysis found that black healthcare professionals were multiple times more likely than their white peers to be investigated and found guilty of FWA.
The Board of Healthcare Funders and Discovery Health say the panel’s final report on FWA investigations rests on flawed methodology and the misinterpretation of data.
Medihelp says its recovery plan is on track, with strong cost controls, younger members, and CMS-approved funding measures set to restore financial stability by 2026.
