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Tag Archives | PMB

Mixed reactions to PMB draft amendments

While medical schemes have welcomed the draft amendments to Regulations 5 and 8 of the Medical Schemes Act (MSA), pertaining to prescribed minimum benefits (PMBs), both the SA Private Practitioners Forum (SAPPF) and the SA Medical Association (SAMA) have voiced concerns about the proposed changes. The two bodies represent the majority of healthcare professionals in the […]

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Doctors, you Have Rights … Use them!

Elsabé Klinck Through doing what we call ‘doctor talks’, I have come to the deep realisation that doctors feel extremely under siege. This is not only as a result of the sheer volume of health-sector changes currently taking place (many in abbreviation form – DCST, HDACC, DHIMS, OHSC – to name but a few), but […]

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Medical Schemes’ Financial Health Not as Bad as Predicted

Despite all the doom and gloom predictions relating to the sustainability of medical schemes in the past few months, the combined health of the industry appears to have improved slightly from the previous years. The Council for Medical Schemes’ (CMS) 2010-2011 annual report showed that, for the first time in three years, the industry as […]

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Third Time Lucky for BHF?

The Board of Healthcare Funders (BHF) is to appeal the High Court ruling of 11 May, which upheld a previous ruling in November 2011, that it did not have the locus standi (legal standing) to bring an application for a declaratory order on Prescribed Minimum Benefits (PMBs). In both cases, the BHF was ordered to pay […]

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Medical Pressures of Today

Dr  AM Levin  Medical practitioners of today are subject to many forms of pressure, among which are the following two important examples. The first is the question of their medical acumen in dealing with the patient’s pathology, and the second is their legal obligation in carrying out their responsibilities both in terms of their relationship […]

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Law in Practice – Requirements for DSPs and Preferred Providers in the Funding Environment

Elsabé Klinck  Designated Service Providers (DSPs), or preferred (so-called ‘participating’) providers, are used by funders (not only medical schemes, but also by employers, insurers, and the likes) to provide services to members, or groups of members in terms of some agreement. Various legal rules impact on the practice of ­designating, or preferring, healthcare practitioners. In […]

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BHF Denied Leave to Appeal against PMB Ruling

The Board of Healthcare Funders (BHF) was denied leave to appeal the order handed down in November 2011, regarding clarification of wording in the Medical Schemes Act Regulations around the payment of Prescribed Minimum Benefits (PMBs). The judgement did not deal with the merits of the case and instead upheld the technical points raised by […]

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Outrage Mounting over DSP ‘Illegal’ Dispensing Fees

The Independent Community Pharmacy Association (ICPA) is adamant that the setting of fixed dispensing fees by some designated service providers (DSP) appointed by medical schemes to deliver chronic medicines to their members is illegal, despite assertions to the contrary by the Government Employees Medical Scheme (GEMS). The apparent disregard of regulated dispen­sing fees, finalised in […]

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PMBs must be paid in full

Prescribed Minimum Benefits (PMBs) must be paid in full. This was the ruling handed down this morning by the Gauteng High Court after the Board of Health Care Funders of Southern Africa (BHF) and the South African Municipal Workers’ Union National Medical Scheme approached the court asking for a declaratory order on the interpretation of […]

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BHF Slated for ‘Sneaky’ PMB Court Action

Private health care providers have lambasted the Board of Healthcare Funders (BHF) for trying to sneak through an urgent court interdict against the Council for Medical Schemes (CMS) to prevent the council from acting against medical schemes not complying with the ‘payment in full’ requirement of Regulation 8 of the Medical Schemes Act, relating to […]

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