The Medical Schemes Act

The Medical Schemes Act

There are close to 100 registered medical aid schemes in South Africa with an annual contribution of more than R84 billion; and this is an industry that needs to follow certain guidelines and rules at all times to ensure proper and fair medical care to members of all medical aid schemes. All medical aid schemes need to be registered with the Council for Medical Schemes, which is a statutory body established by the Medical Schemes Act 131 of 1998 and regulates private health financing through medical schemes.

The Medical Schemes Act consolidates the laws relating to registered medical aid schemes, and it also provides for the appointment of the Registrar of Medical Schemes. This Act serves to protect the interests of members of medical schemes and provides measures to coordinate medical schemes. Every medical aid scheme in South Africa will be subject to the laws and guidelines of this Act, and all medical aid brokers will need to be registered with the Council for Medical Schemes. This serves as a measure to protect the members of medical schemes, and also to provide a guideline for all medical aid representatives to abide by. When you choose to join a medical aid or work via a broker, you should make sure that they are registered with the Council for Medical Schemes. This is especially important if you have not yet heard of a specific service provider, or if you are working with a private broker.

By following the guidelines of the medical Schemes Act, members of all medical aids can be assured that they will be treated fairly and in accordance with the law, as outlined in the Act. This is important, because if a member is treated unfairly, he or she can contact the Council for Medical Schemes to lay a complaint. The case will be investigated and if found that the medical scheme conducted their business in an unlawful manner, they can face a hefty fine or even be de-registered in case of a serious offence. This helps to ensure that all medical aids work according to the law and to always conduct themselves according to the rules and guidelines that govern them. The Medical Schemes Act covers areas such as the registration procedure for medical aids, the manner in which claims are handled, required documentation that needs to be acquired when registering a new member, and the audit process.

The Medical Schemes Act protects both the medical aid provider and the member; ensuring that proper guidelines are followed at all times. It provides a level of service quality that all schemes are required to provide their members with, as well as a guideline that governs the benefits and claims processes of all medical aid plans in South Africa. The Act is in place to guide and protect all parties; and with medical cover being so important, it is essential to ensure that your chosen medical aid has been registered with the Council for Medical Schemes as well.

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