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Fedhealth to challenge medical schemes council on cost of PMB claims
The Council for Medical Schemes Appeal Committee will be asked to reconsider the obligation on medical schemes to pay claims related to the prescribed minimum benefits (PMBs) in full regardless of the rate charged by a healthcare provider.
[Full Story...]
Medical task team will not deal with PMB 'hot potato'
The issue of how much medical schemes have to pay out for prescribed minimum benefits - benefits for life-threatening medical conditions that schemes, by law, must pay for - is not on the agenda for the industry task team, according to the new Registrar of Medical Schemes.
[Full Story...]
Schemes not complying with regulations in many PMB claims - council
You may not be getting the medical scheme benefits you deserve because schemes are failing to comply with prescribed minimum benefit (PMB) regulations, a workshop for medical scheme industry stakeholders heard this week.
[Full Story...]
Medical industry at odds over treating PMBs
Minimum benefits, which are the backbone of your medical scheme, face serious threats of being undermined by legal uncertainties, unsustainable billing practices and non-compliance with the law, key roleplayers said this week.
[Full Story...]
Actuaries develop model to help government estimate how much national health insurance will cost
Actuaries have developed a detailed costing model for national health insurance (NHI) to help the government formulate its health policy for the country.
[Full Story...]
Longer lives: who will cover the shortfall?
The problem of who will pay for our health and other care as we increasingly live longer is a major challenge in both developed and developing countries, the recent International Congress of Actuaries acknowledged.
[Full Story...]
Rise in Oxygen's solvency level
Oxygen Medical Scheme says its solvency level rose to 14 percent at the end of February - still way below the 25 percent required by law but up from last year's low of 11 percent.
[Full Story...]
10 things you should know about income protection (Part 2)
This is the second half of the article on income protection.
[Full Story...]
10 things you should know about income protection (Part 1)
Most South Africans who insure themselves against disability do so with capital, or lump sum, policies. However, these policies have their shortfalls, especially if you become disabled at a relatively young age. Income protection policies, on the other hand, pay you a regular monthly income for the rest of your working life.
[Full Story...]
When it comes down to life or death
Making a living will is one of the kindest things you could do for both yourself and your loved ones, because by speaking for you when you can’t, it can save them from unnecessary stress and expense, and can save you from prolonged pain and suffering.
[Full Story...]
Dispute over doctors' fees set to drag on
A court challenge that could affect how much your medical scheme pays your healthcare provider may remain unresolved for months, with the threat of a large increase in the guideline tariffs hanging over medical schemes and members.
[Full Story...]
Bonitas trustees hope to avoid curatorship
The principal officer of the country's third-largest medical scheme, the Bonitas Medical Fund, has resigned and its board of trustees is expected to offer to resign after the scheme became the subject of a court application to place it under curatorship following irregularities involving millions of rands of members' money.
[Full Story...]
New acting registrar of medical schemes
Health Minister Dr Aaron Motsoaledi has appointed Craig Burton-Durham (pictured above) as the Acting Registrar of Medical Schemes following the resignation of the previous acting registrar, Patrick Matshidze.
[Full Story...]
Scheme merger approved
The merger between Liberty Medical Scheme and Medicover has been approved, the two schemes announced this week.
[Full Story...]
Scheme clarifies PMB position
In an article titled "Medical scheme members lose out on PMB claims" (Personal Finance, September 19), we reported that the Council for Medical Schemes had conducted an audit of four large medical schemes, including the Chartered Accountants Medical Aid Fund (Camaf), and found that 20 percent of prescribed minimum benefit (PMB) claims had not been paid.
[Full Story...]
Dentist 'entitled to his disability benefit'
The Professional Provident Society Insurance Company (PPS), which provides financial products to professionals, wanted a 59-year-old dentist, who suffers from serious heart ailments, blindness in one eye, hypertension and gout, to carry on working.
[Full Story...]
Many scheme members to pay 11 percent more
The announcement by the Government Employees Medical Scheme (Gems) this week that it will raise its contributions by an average of 10.8 percent next year means many scheme members will face increases of about 10 and 11 percent in 2010.
[Full Story...]
Latest
Retirement fund administrator NBC Holdings this week ended its contract with the troubled Private Security Sector Provident Fund.
[Full Story...]
Schemes cut back on top rates to doctors
You could be paying a lot more out of your pocket for consultations with specialist doctors - especially 'super specialists' - as the result of a trend among medical schemes to drop the rates at which they pay these doctors. Schemes are trying to reduce payments to keep your contributions down.
[Full Story...]
Medical scheme members lose out on PMB claims
Lack of knowledge of your rights means that you, instead of your medical scheme, may be paying for the treatment of conditions covered by the prescribed minimum benefits. We report on how you may be misled into believing that claims for these essential benefits are for your account.
[Full Story...]
Members will benefit, say two medical schemes that plan to merge
Liberty Health Medical Scheme and Medicover are proposing to merge into what would be one of the country's biggest medical schemes.
[Full Story...]
Oxygen takes urgent steps to stem outflow of funds
Oxygen Medical Scheme is said to be in a "precarious" financial position and will close two of its options at the end of this month. In addition, benefits have been cut across its remaining options.
[Full Story...]
Discovery tariffs to rise by an average of 9.8%
The country's biggest medical scheme, Discovery Health, has announced an average contribution increase of 9.8 percent for next year.
[Full Story...]
Medical schemes seek to play a role in new national health system
The major debate over national health insurance will be whether a single state-run entity should be responsible for providing all healthcare services or whether medical schemes should have a role to play in paying for health care.
[Full Story...]
Investment income helps schemes to stay afloat
Amid much talk about the unsustainability of private health care in South Africa, the regulator's annual check-up on medical schemes showed that their claims and other expenses again outstripped the contributions that schemes collected from you, the member, last year.
[Full Story...]
Resolution scheme and adminstrator must part
Resolution Health Medical Scheme was this week given three months to move its administration and managed health care away from Resolution Health, the company that currently provides both services to the scheme.
[Full Story...]
What type of severe illness cover will suit you best?
Debates about the merits of full or partial payouts on severe illness policies have been rekindled by the introduction from next week of standard disclosures about payouts on these policies. Severe illness, dread disease or critical illness cover is intended to cover you against the cost of surviving a serious illness.
[Full Story...]
Doctors to fight tariff list in court
Private doctors are continuing with their High Court challenge of the Department of Health's guideline tariffs for private medical services.
[Full Story...]
Existing medical schemes can be part of NHI - proposal
The Board of Healthcare Funders (BHF), which represents most, but not all, medical schemes, yesterday released a proposal for a National Health Insurance (NHI) system that would make use of existing medical schemes, as opposed to a leaked government proposal for an NHI that would replace medical schemes.
[Full Story...]
Oxygen may need until 2013 to reach solvency level
Oxygen Medical Scheme will probably reach the legally required solvency level in 2013 despite the change in its administrator as of today and the resulting saving of about R1.2 million a month, its principal officer said this week.
[Full Story...]
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