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…
Tag: Council for Medical Schemes
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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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GEMS principal officer suspended
The Government Employees Medical Scheme (GEMS) has placed its principal officer, Stan Moloabi, on precautionary suspension while it completes an internal administrative process. GEMS confirmed the decision on Tuesday but did not disclose the nature of the process. Moloabi also confirmed his suspension. The scheme has appointed its chief operating officer, Dr Vuyo Gqola, as acting principal officer. Meanwhile, the…
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Parmed Medical Aid Reform Bill Moves Through Parliament
The National Assembly is considering legislation that could end compulsory membership of the Parmed Medical Aid Scheme for MPs, judges and other public office-bearers. ActionSA MP Dr Kgosi Letlape introduced the private member’s bill. It proposes amending the Parliamentary and Provincial Medical Aid Scheme Act of 1975. Under the amendment, eligible officials would be allowed to remain with Parmed, move…
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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Medscheme has withdrawn its legal application against Bonitas Medical Fund.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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GEMS Contribution Increase Sparks Union Backlash
Public sector unions have criticised the Government Employees Medical Scheme after it failed to secure approval for a lower increase in member contributions. GEMS asked the Council for Medical Schemes to reduce its average increase to 7.5% from July 2026. However, the regulator rejected the proposal. The decision means members will continue paying contributions based on the approved average increase…
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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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GEMS 2026 Contribution Increase Faces Regulatory Scrutiny
The Council for Medical Schemes (CMS) has raised major concerns over a new financial proposal by the Government Employees Medical Scheme (GEMS). The regulator warns that the revised GEMS 2026 contribution increase might threaten the long-term financial stability of South Africa’s largest medical scheme. Public sector unions have consistently pressured GEMS to protect members from rising costs. In response, GEMS…
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Bonitas Tender Dispute Puts Scheme Governance Under Spotlight
The Bonitas Tender Dispute has placed fresh scrutiny on major operational changes at South Africa’s second-largest open medical scheme. The legal matter between Medscheme and Bonitas Medical Scheme was expected to be heard this week. It has now been postponed again. At the centre of the case are four tenders. These shifted key Bonitas functions away from Medscheme and other…
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Section 59 Investigation: CMS Promises Binding Fraud Code
South Africa’s medical schemes regulator says it will implement the recommendations of the Section 59 Investigation into alleged discrimination against black healthcare providers. The commitment was made during parliamentary scrutiny of stalled reforms linked to both the Section 59 process and the Health Market Inquiry (HMI). The Council for Medical Schemes (CMS) launched the investigation after complaints from black providers…
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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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Sizwe Hosmed Curatorship Exposes R522m in Duplicate Claims
South Africa’s medical scheme regulator has escalated its fight to keep Sizwe Hosmed under curatorship. An affidavit filed in the High Court in Pretoria alleges serious governance and payment failures at the troubled scheme. The allegations include potential duplicate claims exceeding R522m, stale claims worth R81m, procurement concerns, and alleged misuse of a corporate credit card. The affidavit was filed…