KeyHealth Medical Scheme v Ngoepe N.O and Others (A203/2021)
KeyHealth Medical Scheme v Ngoepe N.O and Others (A203/2021) [2022] ZAGPPHC 758 (10 October 2022)
The court held that KeyHealth Medical Scheme is prohibited by Regulation 10(6) of the Medical Schemes Act from using a member's Medical Savings Account to fund prescribed minimum benefits. Regulation 8 further obliges the scheme to pay PMBs in full from its risk pool, without co-payment or deductibles. KeyHealth's own Rule 17.5 reinforces this prohibition by stating that no limitations or exclusions apply to PMBs. The court found that KeyHealth's argument, based on the absence of an express prohibition, was flawed; the correct approach is to determine whether there is authorisation for such c…
Source excerpt
- Medical Schemes Act
- Prescribed Minimum Benefits
- Administrative Review
- Regulation Interpretation
- Risk Pool Funding
- Paja Review