RAF clarifies legal position on Constitutional Court judgement & corrects Discovery Health’s misleading statements
The Road Accident Fund (RAF) is concerned by misleading media statements made by Discovery Health Medical Scheme CEO Ryan Noach, where he states “the constitutional court, the apex court in our land, has upheld the decision of the high court”.
The Constitutional Court has ordered as follows: “The Constitutional Court has considered the application for leave to appeal and has concluded that it does not engage the jurisdiction of the court. Consequently, leave to appeal must be refused.” It is apparent from the above that nowhere did the Constitutional Court uphold any decision by the high court or Supreme Court of Appeal. The Constitutional Court simply raised an issue of jurisdiction and did not uphold any decision.
The decision of the high court set aside an internal directive that dealt broadly with past medical expenses paid by medical schemes, issued internally to RAF employees on 12 August 2022. “The RAF has for more than a year now amended that position, in the directive, to assessing each claim on its merits and reject the payment of Prescribed Minimum Benefits (PMBs) and Emergency Medical Conditions (EMCs), which are obligations of Medical Schemes in terms of the Medical Schemes Act (MSA) and Regulations, specifically Section 29(1)(o) and Regulation 7 and 8 of the MSA Regulations. Put differently, RAF will pay any other medical costs by claimants, that are medical scheme members. One will note that this was a departure from the 12 August 2022 directive which was set aside by the North Gauteng High Court, a decision upheld by the Supreme Court of Appeal,” said the RAF CEO Collins Letsoalo. It is therefore incorrect to say the RAF is in contempt of any court judgement.
Furthermore, the North Gauteng High Court on 22 September 2023 unequivocally stated in Paragraph 26 of the it’s judgment by Honourable Judge Khumalo that: “…neither Discovery nor the medical schemes it represents have a right to directly claim from the Fund, the right to compensation being that of the member claimants as the road accident victims (the medical scheme).” (Own emphasis). This legal position has not changed and confirms RAF’s position.
“Medical Schemes are not insurers or insurance but social benefit organizations governed by the MSA and clearly differentiated through the demarcation regulations issued through a Government gazette on 23 December 2016 by the National Treasury. The demarcation framework buttressed the following principles of medical schemes, open enrolment and community rating,” said the CEO of the RAF.
Furthermore, the National Treasury clarifies these in the explanatory memorandum when it states: “The requirement to include Prescribed Minimum Benefits (PMB) in medical schemes extends the social security net to vulnerable groups, ensuring access to healthcare and providing protection from catastrophic out-of-pocket expenditure. By compelling the funding of the PMB package from the common risk pool of a medical scheme, the principle of community rating is achieved across all medical schemes so that everyone is charged the same standard rate for the common PMB package, regardless of the option or scheme they choose to join.” (Own emphasis). Link: https://www.treasury.gov.za/public%20comments/Demarc/Annexure%20B.pdf
The RAF calls on medical scheme members and trustees to refuse this bullying and abuse from administrators of medical schemes. “They are owners of medical schemes and should reject any attempts to be put under duress and undue influence by being threatened with termination of membership when they refuse to claim from the RAF social benefit scheme that has nothing to do with any loss or damage that they have suffered,” said RAF CEO Collins Letsoalo.
Medical Schemes and their administrators are not claimants in terms of the RAF Act and they must continue to pay for PMBs and EMCs “without any deductibles or co-payments” as obligated by the MSA and MSA regulations.
