Tag archives: Medical schemes

Medical schemes cannot refuse to pay for single available treatment of a rare condition because it is not “prevalent”

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 … Continue reading

Jurisdiction of the Financial Services Tribunal: medical scheme matters

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, instituted … Continue reading

COVID-19 and the potential use of medical scheme reserves

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 … Continue reading

Medical scheme member savings accounts are trust property

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 credit of … Continue reading

Contracting out of legislative protection

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 … Continue reading

Draft Demarcation Regulations 2014

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 LTdemarcation@treasury.gov.za … Continue reading