Medical aid benefits case to be heard

2015-06-18 09:52
The Western Cape High Court in Cape Town. (Paul Herman, News24)

The Western Cape High Court in Cape Town. (Paul Herman, News24)

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Cape Town - The Western Cape High Court will on Thursday hear an application related to regulations that force medical aids to pay in full for certain conditions.

The Treatment Action Campaign (TAC), South African Depression & Anxiety Group (SADAG) and People Living with Cancer (PLWC) will bring an application to become friends of the court - amici curiae - in Genesis Medical Scheme's attempt to have regulations that provide for Prescribed Minimum Benefits (PMB) set aside.

"If Genesis were successful, patients would suffer and their rights would potentially be violated," a statement from TAC said ahead of the application.

The minister of health has not opposed the application but the TAC said other parties have also applied to become respondents and their application will also be heard on Thursday.

They include the Council for Medical Schemes, Hospital Association of South Africa, South African Private Practitioners Forum, Multiple Sclerosis Society of South Africa and Infertility Awareness Association of South Africa.

The TAC explained that PMBs "are a defined set of benefits aimed at ensuring all medical scheme members have access to certain minimum health care services regardless of the benefit option they have selected".

Therefore, the cost of diagnosis, treatment and care of PMB conditions - which include chronic illness such as asthma, diabetes, epilepsy, several mental health conditions, HIV/Aids and TB, and all emergency medical conditions - must be paid in full by medical schemes.

This is to give members continuous care and to make sure their benefits do not run out for these conditions.

Genesis wants the Western Cape High Court to review and set aside the PMB regulation on the basis that the regulations, which are made by the minister of health, are out of the minister of health's powers. It believes that the minister can prescribe medical conditions, in the regulations, but the minister cannot say how the medical schemes pay for treatment of these conditions.

The TAC, SADAG and PLWC believe the minister does have these powers.

They will be represented in the matter by SECTION27.

Read more on:    tac  |  section27  |  sadag  |  cape town  |  health

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