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Medical Schemes
Life Healthcare patient numbers slip
Declining patient numbers at Life Healthcare saw the company’s share price drop by double digits last week, with the change being linked to the...
GEMS takes financial strain as member claims rocket
The Government Employees Medical Scheme (GEMS) processes roughly R180m in claims and 22 000 GP visits per day, and has paid out in just...
CMS plans code of conduct for fraud probes after racism complaints
Parliament has been assured by the Council for Medical Schemes (CMS) that it will implement the recommendations of the section 59 investigation into alleged...
Deepening crisis in healthcare affordability: Stats SA survey
With barely 14% of the country’s population covered by medical aid, new data reveal a deepening crisis in healthcare affordability, where race, geography and...
Medical aids in 'witch-hunt' of physiotherapists, Pretoria study finds
The processes used by medical schemes to carry out forensic audits on physiotherapists are unfair, suggests a recent study, which revealed troubling ethical and...
Momentum to spend millions, hire hundreds, for Bonitas takeover
Momentum appears unconcerned about the NHI or a legal challenge from Medscheme, with CEO Jeanette Marais saying the company will fork out millions and...
GEMS faces funding shortfall amid union pressure
The Government Employees Medical Scheme (GEMS) revealed a funding shortfall this week of roughly R2bn after healthcare claims outpaced member contributions in 2025, adding...
MP calls for scrapping of costly medical scheme
Members of Parliament and other office bearers should be allowed to choose their own medical scheme, and not be made to sign up for...
Bonitas-Medscheme row threatens jobs – Sanlam CEO
At least 5 000 jobs are at risk as the legal saga between Medscheme and Bonitas Medical Fund – which stripped it of long-term...
Discovery uses AI prompts to expedite health checks, diagnoses
AI-driven health prompts to Discovery Life clients are boosting the numbers of preventative screenings while lowering their costs of cover, reports Business Day.
The tool...
Unions step up threats over GEMS increases
Union members of the Government Employees Medical Scheme (GEMS) have threatened to withdraw from the scheme – and are investigating legal action, as well...
Medscheme’s case against Bonitas off urgent roll
Medscheme has removed from the court roll its urgent application against Bonitas, in which it seeks to interdict the appointment of two new service providers,...
Medscheme, Bonitas tender battle escalates
Medscheme says it has evidence – supplied by whistle-blowers – that tender processes used by Bonitas Medical Fund to award contracts, including to Momentum...
GEMS given seven days to respond to union demands on steep hikes
The Government Employees Medical Scheme (GEMS) has seven days to respond to the Public Servants Association’s demands to withdraw the 9.8% contribution hike for...
CMS wins bid to replace Sizwe Hosmed curator
The curator of the flailing Sizwe Hosmed medical scheme will be replaced, and it will remain fully functional, according to the Council for Medical...
Planned protests after trade unions reject GEMS hikes
The proposed hefty contribution increase announced by the Government Employees Medical Scheme (GEMS) has been roundly rejected by unions in the Public Service Co-ordinating...
Sizwe Hosmed now under fire from CMS
Troubled Sizwe Hosmed medical scheme, already floundering under curatorship, is now under fire from the Council for Medical Schemes (CMS), which has accused it...
Bonitas cuts ties with Medscheme
A four-decade long relationship has ended after Bonitas severed its ties with medical scheme administrator Medscheme, appointing Momentum and Private Health Administrators (PHA) to...
Medical scheme boss accuses CMS of ‘sabotage’ and racial bias
Medical scheme administrator 3Sixty GSG has alleged that regulators and industry insiders deliberately sabotaged the Sizwe Hosmed medical scheme, which was one of the...
Discovery payment blunder raises ethical issues
Discovery Health’s recent decision to stop the process of recovering fees erroneously paid to pharmacies rightly prevents members from bearing an unfair burden. However,...
Minister vows talks with GEMS over tariffs hike
The latest hikes by the Government Employees Medical Scheme (GEMS) have come under fire from Public Service & Administration Minister Mzamo Buthelezi, who told...
Discovery faces CMS probe as it backtracks on overpayments
Discovery Health took a hammering in the media and from its members this week as it made an embarrassing U-turn on its decision to...
Discovery seeks repayment after overpaying members’ claims
A processing error has led to Discovery Health members being asked to repay money after their claims were incorrectly paid out at a higher...
Medscheme launches urgent bid to pause Bonitas move
Medscheme, which administers medical aid schemes including for Bonitas Medical Fund, has brought an urgent High Court application to suspend or terminate certain requests...
Discovery digs in its heels over cancer treatment for canoe champ
An ongoing struggle with Discovery Health – relating to its stance on covering some of his cancer treatment costs – is frustrating Oscar Chalupsky...
Premium hike slammed by GEMS members
The Government Employees Medical Scheme (GEMS) has defended the 9.8% contribution premium hike for its 2m members for next year, telling outraged unions that...
CMS blocks medical broker with fake certificates
The Council for Medical Schemes has warned the public not to do business with a woman who was running a brokerage with fraudulent accreditation...
GPs dispute exorbitant tariff hike notions
South African GPs have denied that they are overpaid, saying the perception that their tariff increases are in line with the 10% hike in...
Tariffs regulatory vacuum leaves Family Physicians in limbo
Specialist Family Physicians (SFP), short-paid through an unregulated tariff system that treats them as GPs, are victims of a perverse Competition Commission ruling –...
Watchdog deepens Bonitas investigation
The Council for Medical Schemes (CMS) is to launch a forensic investigation into allegedly improper procurement processes at Bonitas, zeroing in on a contract...
SCA to hear BHF arguments in low-cost options appeal bid
The Board of Healthcare Funders (BHF) has welcomed a decision by the Supreme Court of Appeal that will allow it to continue its legal...
Discovery focuses on sleep to boost members’ health
Research by Discovery Health has confirmed that not only does insufficient sleep harm your health but it also dents your wallet, with three years...
Private healthcare monopolies flagged again in new report
Not much has changed in the private healthcare sector over the past half dozen years, and the absence of regulatory intervention, as well as...
Medical aid premium hikes way above inflation
Medical schemes are to increase their premiums by up to four times the current inflation rate of 3.3% in January, reports News24, with Bonitas...
CMS seeks legal advice on racial profiling findings
The Council for Medical Schemes (CMS) is consulting lawyers on how to proceed against the three medical aids named in the Section 59 “racial...
AI helps detect rampant healthcare fraud and waste
While the financial haemorrhage linked to fraud, waste and abuse in the healthcare sector adds up to billions every year (between R22bn and R28bn),...
Medical schemes and the racism probe: correlation not guilt
The medical schemes at the centre of the “racial bias algorithm” furore didn’t conjure up fraud, waste and abuse cases out of thin air,...
Top 10 Discovery claims last year totalled R70m
Ten of the highest member claims paid by Discovery Health Medical Scheme (DHMS) in 2024 totalled R70.5m, the highest (R9.6m) going to a 75-year-old...
Top medical aid schemes guilty of racial bias, inquiry finds
Medical aid schemes and the Board of Healthcare Funders have rejected damning findings from a long-awaited inquiry into racial discrimination and profiling against black...
Political battle over Discovery Medical Scheme trustee election
There was such a flurry of electioneering by nominees vying for three trustee positions becoming vacant this year at Discovery Health Medical Scheme that...