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Tempers flare up as PMB causes more worries

24 November 2015

The medical scheme industry in South Africa has been under significant pressure for over a decade now because of the absence of defined tariffs. This has opened the door for medical practitioners to participate in what can sometimes be described as Wild West Style pricing, and medical schemes are often faced with the unfair situation of having to live with paying the piper.

SCA confirms liability of scheme to fund PMBs in private sector

18 November 2015

The Supreme Court of Appeal (SCA) in Bloemfontein yesterday upheld an appeal by the Council for Medical Schemes (CMS) concerning prescribed minimum benefits (PMBs). The Court per Mr. Justice Leach overturned a judgment of the Western Cape High Court and awarded legal costs to the CMS. The matter concerned the liability of a medical scheme to pay for PMBs obtained from a private hospital as prescribed by the Medical Schemes Act 131 of 1998 (the Act). The contention of the scheme was that in terms of its rules, only services obtained from the state had to be funded under the PMB legislation.

CMS provides advice on choosing a medical scheme and benefit option for 2016

09 November 2015

Prospective and current medical scheme members are encouraged to choose wisely when selecting the right scheme and benefit options for 2016 says the Council for Medical Schemes (CMS), regulator of the medical schemes industry.

CMS says medical schemes in healthy financial state

28 October 2015

The 83 registered medical schemes in South Africa are in a healthy financial state and continue to provide sufficient financing for private medical care, as stated by the Council for Medical Schemes (CMS), regulator of the industry. These schemes are also nowhere close to collapsing as reported in the media since the past weekend.

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The strongest deterrent against FSP compliance missteps is or should be:

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A criminal conviction Debarment Fine or penalty Any of the above can work

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