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.
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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.
Medical scheme vs medical insurance: the risk conversation advisers can’t avoid
In this edition of Cover to Cover, we unpack the structural, regulatory, and underwriting differences that advisers must clarify before recommending either healthcare funding option.
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.
Full Bench adds weight to challenges against RAF medical expense directives
Internal directives cannot displace court orders or long-standing principles governing compensation, says the Western Cape High Court.
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.
Stretch your medical savings: smart strategies for the year ahead
This edition of Cover to Cover looks at how members can plan, track, and optimise their medical savings to reduce out-of-pocket costs and get the most from their benefits.
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.
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.
Transitional delegations under the FSRA pushed to 2028/29
New end-dates extend the temporary allocation of certain supervisory duties to the FSCA and PA while regulatory frameworks are finalised.
‘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.
Co-payments unpacked: the real drivers behind member shortfalls
A practical guide to why co-payments arise, how schemes set them, and how advisers can help clients manage the risk.
