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Medical Schemes
Blow to BHF over collective pricing and PMBs
The Board of Healthcare Funders (BHF) has been unsuccessful in attempts to get the Competition Commission to allow its members to collectively negotiate with...
Union medical aid axes Melomed hospitals
The SA Municipal Workers Union Medical Scheme (Samwumed) has dumped the Melomed Group from its list of approved hospitals, causing an outcry among members...
Discovery aims to launch ‘affordable’ medical aid plan
A low-cost medical scheme targeting new entrants and young professionals is in the pipeline from Discovery Health Medical Scheme, which says it will be...
Reforms vital to end medical aid fraud, waste and abuse
The South African medical aid industry is determined to clamp down on practices undermining the healthcare system, with renewed emphasis and a zero-tolerance stance...
Regulator rules for medical aid members in more than 50% of disputes
The Council for Medical Schemes has said that in the past financial year, it found in favour of more than 50% of members who...
Health Squared members unlikely to retrieve savings after liquidation
While it is still unclear if members of Health Squared Medical Scheme – which was placed in final liquidation in February 2023 – will...
Family wins decade-long legal battle against Profmed
Nearly 10 years after being kicked off her medical aid and accused of not disclosing existing medical conditions, a Cape Town woman who took...
CMS probes medical aid AGM costs amid hefty premium hikes
Medical schemes, under fire for high premium increases for 2025 – which in most cases will be pegged above 10% – are also being...
Health Department dithering over HMI, says BHF
The National Department of Health has denied dragging its heels over plans to make the cost of healthcare more affordable, after the Board of...
Chronic illness fuels substantial medical aid hikes
Private medical scheme members should brace themselves for substantial premium hikes next year, attributed to a combination of a surge in chronic conditions and...
CMS rejects request for autoimmune guidance
The Autoimmune Alliance of SA (AASA) has had its call for guidance on funding costly treatments rejected by the medical scheme industry regulator.
The advocacy...
CMS urged to clarify cover for pricey medicines
The Council for Medical Schemes is “failing South African patients” and needs to clarify the extent to which schemes are obliged to cover costly...
Medical aid membership constant but 'unsustainable'
The number of medical scheme members has stayed nearly constant at 9m over the past decade, according to Sanlam Private Wealth (SPW), which says...
Liberty Health to close doors
Liberty Holdings, wholly owned by the Standard Bank Group, has confirmed its health business is shutting up shop after running at a loss for...
Sizwe Hosmed to launch fraud probe
The Sizwe Hosmed Medical Scheme – placed under statutory management by the Council for Medical Schemes (CMS) last week because of its shaky finances – is...
Regulator appeals for ‘reasonable’ medical aid hike
SA’s medical schemes regulator has appealed to the industry to limit 2025 contribution increases to the SA Reserve Bank (SARB’s) inflation forecast of 4.4% plus...
Sizwe Hosmed in financial trouble as other schemes hike prices
Three years after its debut, Sizwe Hosmed Medical Scheme has been placed under statutory management by the Council for Medical Schemes (CMS), due to...
Discovery sanctioned, again, for misleading advertising
The Advertising Regulatory Board has ordered Discovery to remove or amend advertising material for its severe illness benefit provided by its life insurance business,...
Government's NHI claims are 'fallacies', says BHF
Many of the government’s statements denigrating private healthcare and medical aids – and why it is so critical that South Africa needs National Health...
5 years on, no report on medical schemes’ racial bias inquiry
Five years after the start of an inquiry into alleged racial bias by medical schemes, there is still no final report.
The Council for Medical...
NHI will make it harder to attract skilled staff – law firm
With the signing of the National Health Insurance (NHI) Act into law, it may eventually become harder for companies trying to attract talent, according...
Ministers deliberately ‘demonise’ medical schemes, claims BHF research
Research presented at the annual Board of Healthcare Funders conference this week, including allegations that various Health Ministers have deliberately promoted false claims about...
Stop resistance to NHI, says ANC
While South Africans face the prospect of little or no private healthcare in the future under the National Health Insurance (NHI), in the UK,...
SA medical scheme sector relatively healthy, analysis find
In its latest analysis of the South African medical schemes industry, financial services group Alexforbes said that despite challenges, the sector remains stable.
In its...
What’s driving up medical inflation?
Lifestyle diseases and excessive consultant control are contributors to medical inflation – apart from poor regulatory control of the private sector, which leads to...
Discovery judgments mount amid RAF dispute
Discovery Health says it has obtained judgments totalling more than R170m since the RAF’s controversial directive not to reimburse past medical expenses where a...
One-year reprieve for low-cost health insurers
An 11th hour reprieve has been granted by the Council for Medical Schemes (CMS) to insurers offering cheap primary healthcare cover, giving them another...
Discovery's contempt case against RAF moves a step closer
A full Bench of three judges is to hear the contempt of court application brought by Discovery Health against the financially stressed Road Accident...
CMS seeks to place Netcare scheme under curatorship
In yet another clash with the healthcare industry, and following recent accusations of hostility and harassment, the Council for Medical Schemes (CMS) has applied...
Regulator abusing power and hostile towards medical schemes – BHF
In an unprecedented move, the Board of Healthcare Funders (BHF) has sent a legal letter to the Council for Medical Schemes and the Health...
Drastic surge in medical gap cover
The medical aid industry is struggling to contain inflation, say experts, with insurance underwriters describing regular individual gap payouts to cover medical aid shortfalls...
Report on cheap medical aid options handed to Minister, finally
The Council for Medical Schemes has submitted its report on affordable medical scheme options to Health Minister Dr Joe Phaahla – although the Board...
Fraud and waste costs medical aids billions every year
An eye-popping R30bn – or 15% of total revenue – is being lost by medical aids to fraud, waste and system abuse every year,...
Discovery's 'chronic cover’ ad misleading, regulator finds
The Advertising Regulatory Board (ARB) has ordered Discovery Health to qualify its claim to offer “comprehensive” chronic cover after a complaint by leading business...
Only 15% of South Africans on medical aid
Countless working-class South Africans can no longer afford medical aid, according to general secretary of the Public Service Co-ordinating Bargaining Council Frikkie de Bruin,...
Shrinking proportion of South Africans on medical aid
The number of South Africans belonging to medical schemes overshot the 9m mark for the first time in 2022, but rapid population growth means...
Capping medical aid hikes won’t solve healthcare woes
The stark reality is that the South African private healthcare sector, in its current format, is unsustainable, writes Gary Feldman in Business Day, but...
Mediclinic's alleged irregular billing sparks forensic probes
A whistle-blower’s allegations – that six Mediclinic hospitals are guilty of irregular billing practices – have opened a can of worms, with forensic investigations...
How medical aid premiums are calculated and spent
The Council of Medical Schemes (CMS) recently announced that 2024 monthly premium increases should be capped at 5%, but with permission, this could rocket up...
Consumers shoulder burden of medical aid schemes fraud
Fraud and abuse are being practised by medical schemes that are failing to pay out prescribed minimum benefits (PMB) to members, forcing consumers to...