Gap cover, medical schemes and primary healthcare plans are shifting costs between one another, undermining efforts to contain healthcare spending, actuaries have warned. Four Medscheme actuaries presented the findings at the Actuarial Society of South Africa convention in Cape Town. PMBs squeeze other benefits According to senior actuarial analyst Elizabeth Greyling, prescribed minimum benefits (PMBs) accounted for 70% of healthcare…
Tag: Medscheme
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Sanlam Writes Down AfroCentric to Nil but Won’t Sell
Sanlam has written down its investment in healthcare management group AfroCentric to nil after medical scheme Bonitas moved to end its relationship. Yet, the insurer insists there is still value to extract. The stake will stay. Sanlam CEO Paul Hanratty ruled out any sale. Sanlam owns 60% of AfroCentric, a holding it took three years ago and which has so…
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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Medscheme has withdrawn its legal application against Bonitas Medical Fund.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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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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Parmed Membership: MPs Push To End Compulsory Cover
The debate over political perks has shifted to medical aid. ActionSA MP Kgosi Letlape is lobbying to end compulsory membership of the Parmed medical scheme for MPs and other office-bearers. He argues that elected officials should be able to choose their own scheme. They should also be allowed to opt out entirely. Parmed is a restricted medical scheme. It is…
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AfroCentric Results Show Revenue Surged Significantly
AfroCentric Investment Corporation has released its financial results for the year ending December. The JSE-listed healthcare giant reported a massive spike in revenue. However, the group also faced a significant basic loss. This was primarily due to heavy asset impairments and strategic business disposals. Massive Revenue Growth For AfroCentric The group’s continuing operations showed exceptional top-line growth. Total revenue climbed…
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Bonitas Tender Dispute: Court Action and Tender Controversy
South Africa’s second-largest open medical scheme, Bonitas, is opposing an urgent court application by Medscheme to block the appointment of two new service providers. The Bonitas Tender Dispute centres on Bonitas’ decision to end a 44-year administration relationship with Medscheme. Medscheme has served as its administrator since 1982. Bonitas, which covers more than 730,000 people, has appointed Momentum to take…
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Bonitas Medscheme Split Sees Momentum and PHA Win Contracts
The Bonitas Medscheme Split has become a major topic in the South African healthcare sector. Bonitas Medical Fund, South Africa’s second-largest open medical scheme, has confirmed a major supplier shake-up. It will end its long-running administration relationship with Medscheme and hand key roles to Momentum Health and Private Health Administrators (PHA). The changes cover all Bonitas options except Boncap, its…
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Medscheme Bonitas Legal Battle Over RFPs Escalates Amid Probe
A critical legal dispute is unfolding in South Africa’s private healthcare sector. Medscheme has filed an urgent application with the Johannesburg High Court to suspend or terminate several Requests for Proposals (RFPs) issued by Bonitas Medical Fund. Furthermore, the dispute signals deepening tensions between long-standing partners in the administration of the country’s second-largest open medical scheme. Medscheme Bonitas Legal Battle…
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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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Medical Fraud: A Discussion on Race and Class
The long-awaited final report from the Section 59 inquiry has left more questions than answers regarding medical aid fraud in South Africa. The investigation, initiated by the Council for Medical Schemes (CMS) after complaints of racial bias from healthcare providers, found that while fraud detection methods were fair, black practitioners were disproportionately found guilty of fraud, waste, and abuse (FWA).…
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Racial Bias Report: Are the Claims Valid?
A fuse has been lit in South Africa’s private healthcare industry following the release of a controversial racial bias report. It claims black healthcare providers are disproportionately targeted in fraud investigations. The Section 59 report, submitted to Health Minister Dr Aaron Motsoaledi, alleges systemic racial discrimination by medical schemes. However, leading industry bodies have hit back, labelling the racial bias…