2.3 Registration of a Medical Scheme
Any entity that wants to do the business of a medical scheme, needs to be registered as such through following the proper procedures as stipulated in the Medical Schemes Act and Regulation 2 of the Regulations to the Act. An application to register a medical scheme must be submitted in writing to the Registrar for […]
2.2 Business of a Medical Scheme
In terms of the Medical Schemes Act, the business of a medical scheme is defined as the business of undertaking liability in return for a premium or contribution to- Make provision for the obtaining of any relevant health service. Grant assistance in defraying expenditure incurred in connection with the rendering of any health service. To […]
2.1 Introduction
A medical scheme is a legal entity for the purpose of providing access to health care services for its members. Medical schemes are registered in accordance with the provisions made within the Medical Schemes Act, Act 131 of 1998 as amended. A medical scheme operates as a non-profit organisation. This means that it does not […]
1.5 Council for Medical Schemes
The Medical Schemes Act makes provision for the establishment of the Council for Medical Schemes. The alignment with the objectives of the National Health Policy is clearly evidenced in the functions of the Council for Medical Schemes. The functions of the Council for Medical Schemes are as follows: Protect the interests of medical scheme members […]
1.4 Legislative Environment in Health Care
The health care industry is a complex and highly regulated environment. The subsections following considers the different legislation regulating health care in South Africa. A. National Health Act, 2003 (Act 61 of 2003) The National Health Act, 2003, provides a framework for a single health system for South Africa. It highlights the rights and responsibilities […]
1.3 Private funding Mechanisms
Private individuals access health care in the private sector mainly through the following methods: Medical scheme Health insurance products Gap cover Travel insurance Disability insurance Self-funding The subsections following considers these funding mechanisms briefly. A. Medical schemes The funding through medical schemes is based on a voluntary membership to a medical scheme and entails the […]
1.2 The South African Health Care Industry
The South African health system consists of a combination of two systems to serve the health needs of the country: Large public sector: This sector mainly caters for all people who do not have access to private sector health care. The public health care sector is mainly funded from the national budget. User fees are […]
1.1 Introduction
The first medical scheme in South Africa was established by the employees of the De Beers Consolidated Mines in 1889. Since that time there have been a proliferation of medical scheme-type entities in various forms. From 1956, schemes had to register as “friendly societies” under the Minister of Finance in terms of the Friendly Societies […]