doctor with stethoscope around neck with money in breast pocket

Can your doctor justify his fee?

What is reasonable? Members of Genesis may remember that the Scheme launched an application to the High Court to have regulation 8 to the Medical Schemes Act (“the Act”) struck down.  Regulation 8 is the provision of the Act used by the Registrar of Medical Schemes to force medical schemes to pay any amount claimed…

cheque made out to your doctor from your medical scheme

Part 2: Battle with PMB demystified

Regulation 8 – unplugged As we mentioned in our recent article (Read it here), the issues and complexities around regulation 8 and section 29(1)(p) of the Medical Schemes Act (MSA) and the interpretation thereof in respect of the payment of Prescribed Minimum Benefits (PMBs) are complex.  In addition, the interpretation and application of regulation 8…

cheque made out to your doctor from your medical scheme

Part 1: Battle with PMB demystified

Regulation 8 – unplugged So, what is all the fuss about regulation 8?  The answer is, unfortunately not straightforward. To start at the beginning, section 29(1)(p) of the Medical Schemes Act compels medical schemes to pay in full for any PMB condition that is treated at a public hospital. So far so good because public…

pregnant woman with stethoscope near stomach

VIP Patient on affordable medical aid

A heavily pregnant lady arrived at hospital admissions wanting to be admitted. “I am a member of a very large medical scheme.  Please take me to my VIP suite bed with sea view reserved exclusively for members of my very big medical scheme”, she said. “Sorry madam”, came the reply, “all beds are owned by…

piggy bank covered in christmas lights

Silly Season never ends

Here we are well into 2015.  The year has started badly with the senseless death of innocent people in Paris – some of whom were merely expressing an opinion.  It is sad how intolerant so many people have become over the views of others. Then of course we have others that express views and opinions…

three men standing in queue holding briefcases

Mediese Skemas – Makelaars Kommissie-verdiense

Mediese fonds makelaars bly steeds ietwat van ‘n “warm besprekingspunt” te wees, veral aangesien ‘n paar onlangs die mening in die media en op sosiale platforms uitgespreek het dat kliënte kleiner mediese skemas moet vermy. Hul “boodskap” is dat slegs die grootste mediese skemas met sekerheid u eise kan betaal – ‘n baie vreemde gedagte,…

Medical Aid Broker Commission

Medical aid membership and your broker

Medical aid brokers continue to be something of a “hot topic”, particularly as some have recently expressed opinions in the media and on social platforms that customers should avoid smaller medical aid schemes. Their “message” is that only the largest medical aid schemes can safely pay your claims – a very odd sentiment given that…