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A document available for download from the Council for Medical Schemes website, detailing information related to a legal or regulatory matter involving two medical schemes. It is accessible to the public and can be used for reference by stakeholders such as medical scheme members, brokers, auditors, and regulated entities.
- Who it is for:
- medical scheme members, brokers, auditors, regulated entities, public consumers
- How to act on it:
- Visit the Council for Medical Schemes website and navigate to the PLSvsBestmed file under the relevant section
The document titled 'PS Vs Government Employees Medical Scheme and The Registrar of Medical Schemes' is available for download. It provides official information related to the registration and regulation of this medical scheme by the Council for Medical Schemes.
- Who it is for:
- members of the Government Employees Medical Scheme, regulated medical schemes, medical scheme administrators, the public interested in medical scheme regulation
- How to act on it:
- Visit the Council for Medical Schemes website and navigate to the document listing page
The public can download a legal case record from the Council for Medical Schemes' portal. The document details a dispute between DR TJ Mashamba and the Government Employees Medical Scheme, created on 17 November 2015 and last updated on 18 May 2020.
- Who it is for:
- members of the public, legal professionals, medical scheme stakeholders
- How to act on it:
- Visit the Council for Medical Schemes website and access the 'Access to Information Portal' to download the file
The public can download a legal case record titled 'C Berg vs Profmed Medical Scheme' from the Council for Medical Schemes website. The document is available for viewing and downloading without any application or registration process.
- Who it is for:
- members of the public, medical scheme consumers, legal professionals, researchers
- How to act on it:
- Visit the Council for Medical Schemes website and navigate to the document under the 'Media Centre' or 'Resources' section to download it
The Council for Medical Schemes has made available a discussion document on model rules for medical schemes. This document outlines proposed regulations and standards for medical schemes and is intended for review and feedback by stakeholders.
- Who it is for:
- medical schemes, brokers, auditors, healthcare providers, and members of the public interested in medical scheme regulation
- How to act on it:
- Download the document from the official website using the provided link
The public can download the full legal case document between the Government Employees Medical Scheme (GEMS), the Registrar of Medical Schemes, and NM, AM. This document is available for review and contains details of the dispute as recorded by the Council for Medical Schemes.
- Who it is for:
- members of the public, legal professionals, medical scheme regulators, researchers
- How to act on it:
- Visit the Council for Medical Schemes website and click the 'Download' option next to the document title
The public can download a legal notice issued by the Council for Medical Schemes on 12 July 2016, which concerns a dispute between Discovery Medical Scheme and the Registrar.
- Who it is for:
- members of the public, medical scheme participants, legal professionals, regulators
- How to act on it:
- Visit the Council for Medical Schemes website and download the file from the provided link
The public can download a copy of the official record of the appeal between Discovery Health Medical Scheme and AJ, which details a regulatory decision made by the Council for Medical Schemes.
- Who it is for:
- members of the public, medical scheme participants, legal professionals, researchers
- How to act on it:
- Visit the Council for Medical Schemes website and navigate to the document under the 'Media Centre' or 'Resources' section
For patients with HCC not treatable under PMB regulations, DTP code 260S may be applied based on clinical assessment. This covers comfort care, pain relief, and hydration for patients with imminent death regardless of diagnosis.
- Who it is for:
- patients with HCC not treatable under PMB regulations
- How to act on it:
- Clinical determination by healthcare provider; apply DTP code 260S for comfort care, pain relief, and hydration
Medical schemes must fund the diagnosis and treatment of treatable hepatocellular carcinoma under DTP code 950G. This includes all necessary tests and therapies qualifying as PMB-level care, as defined in the Council's guidelines.
- Who it is for:
- patients with treatable hepatocellular carcinoma
- How to act on it:
- Access diagnosis and treatment through registered medical scheme providers; ensure services are billed under DTP code 950G
The Council for Medical Schemes has published detailed guidelines specifying which tests and treatments qualify as PMB-level care for HCC, helping healthcare providers and schemes determine eligibility.
- Who it is for:
- medical schemes, healthcare providers, insurers
- How to act on it:
- Download the official guidelines from the Council's website
This is a form that auditors and medical schemes can use to apply for or demonstrate compliance with the requirements for auditor approval under the regulations set by the Council for Medical Schemes. It includes questions about auditor qualifications, experience, and adherence to professional standards.
- Who it is for:
- auditors of medical schemes and medical schemes seeking auditor approval
- How to act on it:
- Download the form from the Council for Medical Schemes website and submit it as required by the regulatory process