Genesis Opposes New Medical Aid Regulations

In a move to ensure the right to access to healthcare that the constitution guarantees every South African is realised, the Department of Health is seeking to change Prescribed Minimum Benefits (PMBs) regulations. There are 26 chronic diseases and hundreds of other conditions listed in PMBs and medical schemes are required to pay for these in full. Even if a member reaches the limit of their cover, PMBs regulations aim to ensure that they still enjoy access to healthcare paid for by their scheme. This is in effect what Minister of Health Aaron Motsoaledi intended when he introduced new rules on payment for PMBs.

Genesis Medical SchemePredictably there has been pushback from medical schemes and leading the charge is Genesis, one of the country’s leading medical aid schemes. The firm has initiated a court case seeking to have the minister’s regulations overturned. Genesis argue that Motsoaledi does not have the legal authority to dictate terms to medical schemes and tell them how to pay for treatment of PMBs or any other claims. So far the minister has not responded to the case though he has been cited as a respondent. However, indications from his office are that Motsoaledi will not oppose the motion filed by Genesis.

A statement from his spokesman Joe Maila said the amendments the minister had made to the schemes act will be availed for public scrutiny. He however declined to give details on the amendments. This is the latest twist in the tug of war between medical schemes and the government over the rights of members of these schemes. While the authorities seek, through the Department of Health and the Council of Medical Schemes to help subscribers get full access to care, the schemes are seeking to safeguard their margins against the rising cost of healthcare in the country.

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