Co-payments unpacked: the real drivers behind member shortfalls
A practical guide to why co-payments arise, how schemes set them, and how advisers can help clients manage the risk.
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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.
Waiting periods – how they affect medical scheme benefits
This edition of Cover to Cover explains waiting periods, helping advisers guide clients on when benefits start and strategies to avoid gaps in cover.
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.
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.
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.
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.
Health Minister signals opposition to low-cost benefit options for medical schemes
In its long-awaited report, the Council for Medical Schemes says its preferred recommendation is not to introduce LCBOs.
Majority judgment ‘does not alter’ RAF’s liability for medical scheme members’ claims
The High Court in Cape Town rejects the Road Accident Fund’s contention that the Mlambo judgment has altered the legal landscape.
Rising costs prompt members to weigh medical scheme options
Downgrading to a lower plan may appear to be a cost-saving strategy, but it frequently results in increased out-of-pocket expenses.
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.
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.
