Medical Schemes

Medical schemes operate within the private health care funding sector in South Africa, which is distinct from private health insurance.  The Medical Schemes Act is a unique piece of legislation worldwide in that in provides for open enrolment (subject to its rules, a medical scheme may not refuse to accept any person as a member or dependant), community rating (opposite of risk rating) and prescribed minimum benefits, which are designed to eliminate discriminatory practices sometimes found in private health insurance and set a minimum standard of benefits that all members and their dependants are entitled to.

Our experienced practitioners provide clients with sound, practical advice to guide them through the challenging regulatory environment of the medical schemes industry.  Our services include:

  • Administration;
  • Dispute resolution, litigation;
  • Drafting rules, funding policies, administration agreements, , managed healthcare agreements, capitation agreements and agreements with healthcare providers
  • Managed healthcare;
  • Medical scheme governance;
  • Privacy and data protection laws;
  • Prescribed minimum benefits; and
  • Regulatory environment and the Medical Schemes Act, 1998.

For more information contact: Randhir Naicker