A KeyHealth PMB ruling requires the medical scheme to fund a teenager’s rare blood disorder treatment in full, without membership conditions. The Council for Medical Schemes (CMS) appeals committee issued its decision on 29 October. However, KeyHealth has notified the registrar that it intends to appeal to the CMS appeals board. The case involves a 15-year-old with paroxysmal nocturnal haemoglobinuria,…
Tag: CMS
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Six Factors Driving Medical Scheme Increases in 2027
Medical scheme increases for 2027 range from 7.35% to 8.9%, as rising healthcare utilisation, ageing membership and expensive new treatments continue to push costs above inflation. Industry representatives say schemes must raise contributions to cover growing claims expenditure. According to the Council for Medical Schemes (CMS), healthcare costs can absorb up to R96 of every R100 contributed. Why Medical Scheme…
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Medical Aid Contributions for 2027 from Discovery and Momentum
TWO of South Africa’s largest open medical schemes have unveiled their 2027 medical aid contribution increases. Discovery Health Medical Scheme (DHMS) is raising rates by an average weighted increase of 8.2%. Momentum Health is raising rates by 7.9%. Both framed the increases as a response to mounting medical inflation. Discovery: 8.2% on average DHMS contributions will rise between 7.4% and…
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Medscheme Bonitas Court Bid Withdrawal Clears CMS Probe
Medscheme has withdrawn its legal application against Bonitas Medical Fund. The decision clears the way for the Council for Medical Schemes (CMS) to continue a forensic investigation into disputed procurement processes. The legal action concerned contracts for medical scheme administration, managed care, marketing and sales distribution. Medscheme claimed to have evidence of significant irregularities in tender processes involving Bonitas’s BonCap…
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Sizwe Hosmed Curator Replacement Ordered By High Court
The medical schemes regulator has won its bid to replace Sizwe Hosmed’s curator. This successful Sizwe Hosmed curator replacement, according to the Council for Medical Schemes (CMS), will not disrupt the scheme. It also stressed that Sizwe Hosmed remains fully operational. A High Court order handed down on Wednesday in Pretoria confirmed Ian Fleming as curator with immediate effect. He…
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Dis-Chem MyHealth Partnership Defends Retail-Led Cover
Dis-Chem has defended its health insurance partnership with Centriq and Kaelo after a ruling by the Council for Medical Schemes (CMS). The pharmacy retailer says the decision clarifies the process. It argues it is not a warning shot against retail-led healthcare models. The CMS found that changes to the branding and presentation of Centriq’s MyHealth insurance products under the Dis-Chem…
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Dis-Chem Insurance Branding Non-Compliant says CMS
A regulatory dispute could ensnare thousands of South African health insurance policyholders following a Council for Medical Schemes (CMS) finding that Dis-Chem’s branding breached the Medical Schemes Act. Davizro | iStock/695273346 The CMS ruled that Centriq Insurance Company’s decision to market its MyHealth Core and MyHealth Vital products under the Dis-Chem name amounted to an unauthorised name change. In the…
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Bonitas Faces Investigation for Procurement Irregularities
The Council for Medical Schemes (CMS) has officially launched a forensic investigation into Bonitas, the nation’s second-largest open medical scheme. Bonitas faces investigation over allegations of improper procurement processes related to a key contract for its low-income option. The investigation will focus specifically on a contract awarded by Bonitas to Private Health Administrators (PHA) for the administration of its Boncap…
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Bonitas Medical Scheme Faces Procurement Rigging Claims
Bonitas Medical Scheme, one of South Africa’s largest medical aids, manages a R20 billion fund. It is facing explosive allegations of systemic capture following the emergence of a new whistleblower report. A flash drive containing emails, draft contracts, and internal communications allegedly reveals a concerted effort. Senior executives, trustees, and favoured consultants aimed to rig procurement processes and redirect lucrative…
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Upfront Medical Aid Payments a Growing Concern
Upfront medical aid payments cost members of medical aid schemes a staggering R43 billion last year. This is a situation the industry regulator says is causing significant financial hardship and worsening health inequalities. The Council for Medical Schemes (CMS) revealed the figure in its 2023-24 industry report. It highlights a system where members are increasingly shouldering costs that they expect…
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Medical Aid Premiums to Continue Outpacing Inflation
Multiple sources are warning South African consumers to brace for continued high increases in their medical aid premiums. Experts expect costs to keep rising significantly faster than general inflation. The caution comes from Adrian Gore, CEO of Discovery, the country’s largest medical scheme administrator. He suggests that the underlying drivers of medical inflation continue to be a persistent challenge for…