MD and Another v Medihelp Medical Scheme and Another [2022] ZAGPPHC 640
An urgent application was brought to the High Court by the mother of a three-year-old child (“Z”) who has been diagnosed with a rare genetic condition, Hunters Syndrome MPS II (“MPS II”). Z has been a member of the respondent medical scheme from
A medical scheme aggrieved by a decision of the Registrar for Medical Schemes must appeal to the Council for Medical Schemes and not the Financial Services Tribunal, even if the decision relates, broadly, to financial sector laws.
In Medihelp Medical Scheme v The Registrar for Medical Schemes and Another, the Council for Medical Schemes,
Medical scheme trustees cannot take a business as usual approach during the COVID-19 pandemic. Boards should be giving thought to the value of their reserves and whether using such reserves would be of benefit to members. At a minimum, trustees need to understand the options available to them when considering using scheme reserves.
In terms
Coronavirus is yet to test the rules of medical schemes.
While it has been reported that a virus like COVID-19 would not usually be covered as a prescribed minimum benefit condition, where the virus amounts to an emergency condition then it will fall within the PMB legislation. In addition, to the extent that the virus
The pending changes to the Medical Schemes Act and the Long-term and Short-term Insurance Acts to accommodate the demarcation regulations were made on 1 April 2017 including the new definition of ‘business of a medical scheme’.
The definition of ‘business of a medical scheme’ in the Medical Schemes Act 1998 makes it clear that if
Members’ funds allocated by medical schemes to their members’ savings accounts are trust property in terms of the Financial Institutions (Protection of Funds) Act 2001 (FI Act) and must be accounted for separately.
Section 35(9)(c) of the Medical Schemes Act provides that the liabilities of the medical scheme must include the amounts standing to the
The law obliges medical schemes to pay the costs of treating prescribed minimum benefit conditions in full. The Supreme Court of Appeal in The Council for Medical Schemes v Genesis Medical Scheme provides a useful reminder of when a party may waive rights conferred by law for their benefit.
The Medical Schemes Act does not
Medical scheme rules may have no application if they fail to fulfil statutory law. The relationship between medical schemes and their members is not only governed by the medical scheme rules but primarily by obligations imposed by statute.
The public policy considerations taken into account in the Medical Schemes Act which give rise to prescribed
The second Draft Demarcation Regulations were published by National Treasury for comment.
The draft regulations deal with the demarcation between insurance business and the business of a medical scheme. Here is our analysis of the draft regulations.
Interested parties must comment by 7 July 2014.
Comments must be sent to Ms Reshma Sheoraj at