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.
The comment comes amid a growing standoff between organised labour and GEMS after the scheme announced a 9.8% contribution increase for 2026.
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.
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,
An accelerated 19% contribution increase is designed to correct historic under-pricing and shore up reserves.
This edition of Cover to Cover explains medical scheme dependant rules, required documentation, and how advisers can help clients keep their families covered.
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 Supreme Court of Appeal will hear arguments on the merits if the appeal is upheld.
The curator will assess Sizwe Hosmed’s finances and recommend whether it should merge, be liquidated, or continue.
Statistical analysis found that black healthcare professionals were multiple times more likely than their white peers to be investigated and found guilty of FWA.
A significant ruling by the Appeal Board rendered the processes outlined in the circulars published in 2022 invalid.
The High Court, endorsing the minority judgment’s view, rules the Fund must pay the medical expenses covered by Discovery Health.
The outcome of Discovery Health’s appeal before the SCA will affect the outcome of the member’s claim for R1.4 million.
The Board of Healthcare Funders says it will appeal after the High Court dismissed its application on procedural and substantive grounds.
Insurers are allowed to offer primary healthcare policies for an additional two years pending the finalisation of a framework for low-cost benefit options.
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.
