Rare disease funding is under scrutiny after the Council for Medical Schemes (CMS) Appeals Committee ordered KeyHealth to cover a teenager’s treatment in full. The Board of Healthcare Funders (BHF) says the case shows why schemes need a way to share the cost of exceptionally expensive treatments. The 15-year-old has paroxysmal nocturnal haemoglobinuria, a rare blood disorder. Treatment with AstraZeneca’s…
Tag: Board of Healthcare Funders
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Prescribed Minimum Benefits and Cost Control Solutions
Medical scheme members cannot keep absorbing above-inflation increases or downgrading to cheaper options indefinitely, the Board of Healthcare Funders (BHF) says. The industry body is therefore calling for long-delayed reform of prescribed minimum benefits (PMBs) and collective tariff bargaining. BHF managing director Katlego Mothudi told Moneyweb that reform must address what schemes cover. The BHF has written to the Council…
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Medical Aid Contributions: 3.8% Target Won’t Fix Affordability
A 3.8% guideline for 2027 medical aid contributions will not make private healthcare more affordable, the Board of Healthcare Funders (BHF) says. Instead, managing director Dr Katlego Mothudi says structural reforms are needed to tackle rising hospital and specialist costs and higher utilisation. Unexplained component in the 2027 guideline Speaking in a broadcast interview, Mothudi said the main problem lies…
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Medical scheme contributions: BHF challenges CMS
Medical scheme contributions for 2027 have become a point of contention between the Board of Healthcare Funders (BHF) and the Council for Medical Schemes (CMS). The BHF has challenged the regulator’s guidance that schemes anchor next year’s contribution increases at 3.8%. It argues that the figure does not adequately reflect the cost pressures facing the industry. The association represents schemes…
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Medical Scheme Clawbacks Upheld By High Court
The South African Society of Physiotherapy has lost its legal challenge against medical scheme clawbacks. The High Court in Pretoria dismissed the society’s application to have Section 59(3) of the Medical Schemes Act declared unconstitutional and invalid. The judgment ends a five-year legal battle involving the Minister of Health, the Council for Medical Schemes and the country’s medical schemes. The…
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Parliament’s NHI Process: ConCourt Tests Public Input On NHI
South Africa’s highest court will this week scrutinise Parliament’s NHI Process in two challenges that could reshape the National Health Insurance (NHI) rollout. The Constitutional Court has set aside three days, from 5 to 7 May 2026, to hear applications brought by the Board of Healthcare Funders (BHF) and the Western Cape government. The cases do not yet test the…
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NHI ConCourt Challenge: What’s At Stake For The Health System
South Africa’s National Health Insurance Act is one of the most ambitious legislative reforms since democracy’s advent. Its goal, universal health coverage, is widely supported. But ambition alone does not make legislation constitutional, and the upcoming NHI ConCourt Challenge will test this. The Board of Healthcare Funders (BHF) will appear before the Constitutional Court from 5 to 7 May. Its…
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NHI Constitutional Court Challenge: Key Issues Unpacked
South Africa’s National Health Insurance (NHI) project is heading into a critical legal test. President Cyril Ramaphosa is expected to argue before the Constitutional Court that the NHI is a necessary step to address deep inequality in access to healthcare inherited from apartheid. The case focuses on whether Parliament followed a constitutionally sound public participation process when passing the NHI…
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Medical Tax Credits: Schemes Urge Godongwana for Budget Boost
South Africa’s two biggest industry bodies for medical schemes are urging Finance Minister Enoch Godongwana to keep medical tax credits in place and increase their value in the upcoming Budget. They argue the credits are critical to keep private cover affordable for working families, especially as costs rise. The call comes as the health department pushes to phase out medical…
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NHI Implementation on Hold After Presidential Undertaking
President Cyril Ramaphosa has formally undertaken not to bring any part of South Africa’s National Health Insurance (NHI) Act into operation until the Constitutional Court has ruled on two challenges focused on public participation. The undertaking was conveyed in a letter dated 20 February from the Office of the State Attorney. It states the president “undertakes not to promulgate any…
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Bogus Doctors in focus as HPCSA Warns on Rising Fraud
The Health Professions Council of South Africa HPCSA is warning that unregistered practitioners are putting lives at risk. New cases of “bogus doctors” continue to surface. “If you’re in the hands of an unqualified person, you’re as well as dead,” says. The council is responsible for registering medical doctors and other health professionals. It also investigates complaints about practitioners practising…