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.
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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.
Cap on healthcare broker fees increases by 4%
The new limit applies to contributions received from 1 January.
Discovery vs RAF: CMS executive says High Court got it wrong
A regulatory expert believes the judgment misinterpreted key legal principles in its ruling on the RAF’s obligation to reimburse medical schemes.
Bestmed defends 12.75% 2025 contribution hike as industry faces cost pressures
Bestmed states pending rules for low-cost benefit options have further complicated efforts to reduce costs for members.
ConCourt clarifies when medical schemes can cancel membership for non-disclosure
Medical schemes cannot cancel membership based solely on the non-disclosure of a diagnostic procedure that does not lead to the diagnosis of a serious medical condition.
Rise in complaints about medical schemes clawing back losses allegedly linked to fraud and waste
Schemes and healthcare professionals are at odds over whether these recoveries are justified, says the Council for Medical Schemes.
Medical scheme placed under statutory management as reserves plummet
The deterioration in Sizwe Hosmed’s reserves is attributed to ‘benefit under-pricing and historically unreliable budgetary and forecasting processes’.
CMS webinars for brokers, trustees, and medical scheme employees
The Council will provide a CPD-accredited training session for newly appointed healthcare brokers in August.
Medical schemes get costlier as reform takes a back seat to NHI
Members of medical schemes are paying up to 30% more because the regulatory system broke down after the government’s focus shifted to NHI.
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.
Primary health insurance policies can be sold for another year
The exemption will remain in force for 12 months unless a decision is made on low-cost benefit options before 31 March 2025.
