Tag: Medical Schemes Act

In the case of Keyhealth Medical Scheme v the Honourable Mr Justice SM Ngoepe N.O, the Registrar of Medical Schemes and William Reed, Case Number: A203/2021, a full bench of the Pretoria High Court held that prescribed minimum benefits (PMBs) must not be paid from a member's personal medical savings but must be paid from the medical scheme's PMB risk pool. 

The Medical Schemes Act (MS Act) requires a person to be accredited by the Council for Medical Schemes (CMS) as a broker, before being allowed to provide “broker services”. The MS Act defines “broker services” as the provision of service or advice in respect of access to or benefits offered by a medical scheme.

Brokers are a feature of the medical schemes market and subject to extensive regulation in terms of the Medical Schemes Act, its regulations, and circulars issued by the Council for Medical Schemes (CMS). The CMS has announced it intends to revise Circular 20 of 2010, the prevailing circular dealing with brokers and has called for public comment.

If you are a medical scheme member, you have probably heard the phrase Prescribed Minimum Benefits or PMBs. But precisely what are they, who are they for, and when do they get used? It might help to answer some of your questions and concerns and help you to understand what you are entitled to and how PMBs fit into your medical aid cover.

The recent presentation at the Board of Healthcare Funder’s annual conference by Christoff Raath, joint-CEO of Insight Actuaries, should garner wide support from the private healthcare industry. Raath quite rightly lamented the incredibly slow pace and prevaricating by the Council for Medical Schemes (CMS) in developing lower cost medical scheme options that could introduce millions more members into the private health sector.

Many South African’s feel the economic impact of the pandemic, which has ultimately affected their pocket. People are forced to make difficult decisions in order to rearrange their finances to suit their current financial constraints. 

New members applying to medical aid schemes need to understand that there is a waiting period before they may claim. New members pay full contributions to the medical scheme during this waiting period, but cannot yet claim for full benefits from the scheme.

Pursuant to a circular published by the Council of Medical Schemes (CMS) on 26 March 2020 (the Circular), declaring COVID-19 a prescribed minimum benefit, as that term is defined in the Medical Schemes Act No. 131 of 1998 (MSA), the Minister of the Health has amended the MSA to align with the Circular. 

The circular released on the 10th April 2020 by the Council for Medical Schemes (CMS) entitled 'COVID-19 Medical Schemes Industry Guidelines' outlines the relief measures which schemes may offer their members – individuals and employer groups – detailing what they can and can’t do to alleviate the economic suffering during this pandemic and lockdown period.