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.
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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.
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.
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,
Sizwe Hosmed making substantial progress, says curator
An accelerated 19% contribution increase is designed to correct historic under-pricing and shore up reserves.
From spouses to parents: understanding medical scheme dependants
This edition of Cover to Cover explains medical scheme dependant rules, required documentation, and how advisers can help clients keep their families covered.
Medihelp to appeal contempt judgment in Elaprase case
Medihelp says it will challenge the judgment while the cost of Elaprase awaits a final decision by the CMS Appeal Board.
CMS: No complaints about brokers’ conduct in 2024/25
The Council for Medical Schemes’ latest annual report shows a decline in registered complaints – continuing a three-year downward trajectory.
SCA to hear BHF’s appeal on low-cost medical options
The Supreme Court of Appeal will hear arguments on the merits if the appeal is upheld.
Provisional curator to advise on future of medical scheme
The curator will assess Sizwe Hosmed’s finances and recommend whether it should merge, be liquidated, or continue.
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.
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.
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.
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.
