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Court ruling keeps basic medical aid cover

Nov 07 2011 16:50

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Johannesburg - Prescribed minimum benefits, which protect members of medical schemes, would remain in place, the Pretoria High Court ruled on Monday.

"We are delighted with this ruling," said registrar of medical schemes and CEO of the council for medical schemes, Monwabisi Gantsho.

The law which prescribed minimum benefits would stand, the council for medical schemes said in a statement.

The council for medical schemes was the first of 13 respondents in the matter.

The ruling came as a result of the Board of Healthcare Funders of SA (BHF), which challenged regulation eight of the Medical Schemes Act 131 of 1998 and asked the court to pronounce on it.

BHF represents a number of medical schemes and administrators, and was later joined by the SA Municipal Workers' Union national medical scheme.

Regulation eight states that medical schemes must pay for the diagnosis, treatment and care of all prescribed minimum benefits conditions in full, or at the price charged by the healthcare provider.

Prescribed minimum benefits are the minimum level of diagnosis, treatment and care that a medical scheme is obliged by law to cover.

The scheme must pay for all prescribed minimum benefit conditions in full and from its risk pool, not from a clients' savings account.

These benefits include 270 serious health conditions such as tuberculosis and cancer, any emergency condition, and 25 chronic diseases including epilepsy, asthma and hypertension.

"Prescribed minimum benefits are a cornerstone of the medical schemes act and they were included in legislation for a good reason: to protect beneficiaries against unforeseen ill health that may prove financially catastrophic for them," Gantsho said.

"As the regulator tasked with looking after the best interests of medical scheme beneficiaries, we are happy that our courts have confirmed the need for such protection in law."

      
nhi  |  medical aid  |  private hospitals

 
 
 

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