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.
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BHF and Discovery challenge section 59 report’s conclusions
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.
Discovery members ‘make the Smart move’, while KeyCare loses ground
The decline in KeyCare Plus membership reflects a reduction in employer subsidies and fewer mandates for medical scheme membership, DHMS says.
Medihelp’s solvency dips again, but scheme says recovery plan is working
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.
Bestmed marks sixth year of membership growth
Despite economic headwinds and high claims ratios, Bestmed grew net membership by 4.4% in 2024, bolstered by strong solvency and a R164.4m surplus.
CMS will issue a new circular on appointment of healthcare brokers
A significant ruling by the Appeal Board rendered the processes outlined in the circulars published in 2022 invalid.
HFA warns: NHI will slash healthcare, raise taxes, and drain the economy
The Health Funders Association, which represents nearly half of SA’s private healthcare market, is the latest organisation to launch a legal challenge against the NHI Act.
RAF loses another medical scheme member liability case
The High Court, endorsing the minority judgment’s view, rules the Fund must pay the medical expenses covered by Discovery Health.
Pandemic pricing pains catch up with medical schemes – higher contributions ahead
Three medical schemes fell below the 25% solvency threshold in 2023.
Medical expenses | Court grants leave to appeal in member’s dispute with RAF
The outcome of Discovery Health’s appeal before the SCA will affect the outcome of the member’s claim for R1.4 million.
Major setback for medical schemes in legal battle over low-cost options
The Board of Healthcare Funders says it will appeal after the High Court dismissed its application on procedural and substantive grounds.
CMS extends exemption for primary healthcare policies
Insurers are allowed to offer primary healthcare policies for an additional two years pending the finalisation of a framework for low-cost benefit options.
Medical schemes push ahead with case over Covid test pricing
The Competition Tribunal has dismissed key objections from major pathology laboratories, moving the medical schemes closer to having their damages claim heard in the High Court.
Court orders RAF to pay medical scheme members’ claims
Another attempt by the Road Accident Fund to contest liability based on the ‘majority decision’ against Discovery Health has fallen through.
Bonitas celebrates brokers for driving the scheme’s growth
Industry leaders such as AlexForbes, Avoir Corporate Healthcare, and Hippo Advisory shone bright at the third annual Top Broker Awards.
Coalition: government’s ‘piecemeal’ healthcare reforms fall short
The Universal Healthcare Access Coalition says the proposed tariff-setting measures for private healthcare side-step essential reforms.
What the BHF and HASA are arguing in their legal challenges to the NHI Act
The Board of Healthcare Funders wants to see records that disclose whether President Cyril Ramaphosa disregarded constitutional concerns before signing the NHI Act into law.
