How the NHI shake-up may impact South African healthcare
There are concerns about the sustainability of private providers and whether the public will face higher costs to maintain their current level of healthcare.
#medicalschemes
Adjudicator to propose holding trustees personally accountable for non-payment of contributions
Muvhango Lukhaimane will also consult with trustees on guidelines for naming and shaming problematic funds, administrators, and employers.
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Looking back at this year’s FPI Professional’s Convention
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Webinars on how to investigate misconduct and address poor performance
NHI ‘collaboration’ means different things to the government and the private sector
In an interview this week, President Ramaphosa was asked whether South Africans will pay higher taxes to fund NHI.
Medical schemes assure members that NHI is a long way off
The expected legal challenges to the legislation and the pressure on the state’s finances could delay full implementation of the system for many years.
CMS invites BHF to collaborate, criticises ‘forum-shopping’ tactics
The BHF’s canvassing of key policy issues in the public domain via a ‘deliberately leaked’ lawyer’s letter indicates the organisation ‘has run out of creative ideas’.
Council mulls outsourcing appeal adjudication amid BHF accusations
The CMS asserts that medical schemes have frequently disregarded the existing appeals procedures, exploiting them to the detriment of members’ interests.
CMS denies it is sabotaging medical schemes to boost NHI
The regulator comes out swinging in its response to the Board of Healthcare Funders’ claims of bullying and curatorship abuse.
How can gap cover add value for my clients and how do I help them choose the right policy?
The difference between medical scheme cover and medical insurance – and where gap cover fits in.
Medical schemes experience significant drop in net results for 2022
In 2022, the industry saw a net income of R2.57 billion – down from R12.18bn in 2021 – and faced an operating deficit of R6.155bn, the largest in 23 years.
RAF claims ‘out of ICU’, but hundreds of millions still owed to medical scheme clients
Despite Parliament’s commitment to prioritise the Road Accident Amendment Bill, there has been no further communication about the comments submitted on the draft legislation.
RAF’s legal rope nearing its end as High Court tells fund to pay R33 million
The recent ruling by the High Court underscores the Road Accident Fund’s obligation to reimburse medical scheme members for past medical expenses covered by the injured person’s medical scheme after a motor vehicle accident.
Forensic investigation finds no evidence of billing fraud at Mediclinic
ENSafrica identified some incidents involving mistakes or unintended errors, but these were ‘random and minuscule’.
Board of Healthcare Funders takes Council for Medical Schemes to task in lawyer’s letter
The BHF raises 10 issues, including the ‘misuse’ of curatorships, whether NHI is informing policy prematurely, and the absence of low-cost benefit options.
CMS training for new medical scheme trustees
The induction programme takes place online over two days in February.
Cap on healthcare broker fees increases by 5%
The new limit applies to contributions received from 1 January.
Surging specialists’ fees drive sharp increase in gap insurance claim values
A comprehensive option is no guarantee that your medical scheme will pay in full your bills for in-hospital treatment, says Sirago Underwriting Managers.
Medical schemes regulator flags ‘extravagant’ AGM expenses
Council for Medical Schemes urges investigation into ‘worrisome’ AGM costs as new research report reveals disparities within the medical scheme landscape.
