Tag: MedicalSchemes
Cancer gap claims surge signals warning
Our analysis of cancer-related gap claims we paid between 2020 and 2024 shows a staggering increase. The increase relates to gap claim volumes for initial cancer diagnosis, treatment co-payments and shortfalls. This cancer gap claims surge reflects growing pressure on healthcare funding. We operate as a gap cover provider, and GENRIC Insurance Company Limited underwrites the business.
Healthcare reform must be built on stability, not slogans
Healthcare policy in South Africa has become emotionally charged. While National Health Insurance (NHI) is often presented as an inevitable endpoint, medical schemes are portrayed as temporary structures awaiting replacement. The 2026 Healthcare Budget tells a more sober story. What stood out to me was not dramatic reform but restraint. The government did not introduce a new NHI tax.
Healthcare fraud crisis – technology, trends and tactics
Fraud, waste and abuse in South Africa’s private healthcare sector drains the system’s ability to deliver quality care. The issue remains largely unspoken. It does not make headlines in the way political corruption does. However, it is arguably just as damaging. It undermines the affordability and sustainability of medical cover for millions of South Africans.
The bare minimum of PMB is that it needs to change
If you’re a member of a medical scheme, you should understand Prescribed Minimum Benefits (PMBs). By law, all medical schemes must offer these benefits to every member. This requirement applies regardless of the scheme you choose. PMBs guarantee access and cover for a minimum, defined list of healthcare benefits. In effect, they represent the bare minimum of PMB protection in the private healthcare system.
