Advanced Search

Medical Schemes Act


Published: 1998-12-02

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$40 per month.
Medical Schemes Act [No. 131 of 1998]
STATUTES OF THE REPUBLIC OF SOUTH AFRICA–MEDICmE, DENTISTRY AND PHAWACY
MEDICAL SCHEMES ACT NO. 131 OF 1998
[ASSENTED TO 20 NOVEMBER, 1998] [DATE OF COMMENCEMENT TO BE PROCLAIMED]
(English text signed by the President)
ACT
To consolidate the laws relating to registered medical schemes; to provide for the esta- blishment of the Council for Medical Schemes as a juristic person; to provide for the appointment of the Registrar of Medical Schemes; to make provision for the registration and control of certain activities of medical schemes; to protect the interests of members of medical schemes; to provide for measures for the co-ordination of medical schemes; and to provide for incidental matters.
ARRANGEMENT OF ACT
CHAPTER 1
DEF~ITIONS
1. Definitions
2. Application of Act
CHAPTER 2
APPLICATION OF ACT
CHAPTER 3
COUNCIL FOR MEDICAL SCHEMES
Part 1: Council
3. Establishment of Council for Medical Schemes
4. Constitution of Council
5. Disqualification as member of Council, and vacation of office
6. Term of office of member of Council
7. Functions of Council
8. Powers of Council
9. Committees of Council
10. Meetings of Council
11. Remuneration of members of Council and committees 12. Funds of Council
13. Accounting officer
14. Annual report
15. Consultation between Minister and Council
16. Cases of improper or disgraceful conduct
.- (Issue No 33- Supplemenfav) 101
STATUTES OF THE REPUBLIC OF SOUTH AFWCA–MEDIC~, DENTISTRY AND PHARMACY Medical Schemes Act, No. 131 of 1998
17. Liquidation
Part 2: Registrar, Depu@ Registrar and staff of Council
18. Appointment of Registrar and Deputy Registrar of Medical Schemes
19. Staff of Council
CHAPTER 4
MEDICAL SCHEMES
20. Business of medical scheme
21. Use of designation “medical scheme”
22. Application for registration
23. Name of medical scheme and change of name
24. Registration as medical scheme
25. Notification of registration
26. Effect of registration
27. Cancellation and suspension of registration
28. Prohibition of membership of, and claims against, more than one medical scheme
CHAPTER 5
RULES OF MEDICAL SCHEME
29. Matters for which rules shall provide
30. General provisions to be contained in rules
31. Amendment of rules
32. Binding force of rules
CHAPTER 6
BENEFIT OPTIONS
33. Approval and withdrawal of benefit options
34. Prohibition on cession and attachment of benefits
CHAPTER 7
FINANCIAL MATTERS
35. Financial arrangements
36. Auditor and audit committee
37. Annual financial statements
38. Registrar may reject returns
CHAPTER 8
DOCUMENTS
39. Requirements in regard to documents to be deposited with Registrar
40. Effect of Registrar’s certificate on documents
41. Right to obtain copies of, or to inspect certain documents
(Issue No 33- Supplementa~) 103
,,-
STATUTES OF THE REPUBLIC OF SOUTH AFRICA–MEDICINE, DENTISTRY AND PHAWACY Medical Schemes Act, No. 131 of 1998
CHAPTER 9
POWERS OF REGISTRAR
42. Registrar may require additional particulars
43. Enquiries by Registrar
44. Inspections and reports
45. Persons not registered to furnish information
46. Removal of member of board of trustees
CHAPTER 10
COMPLAINTS AND APPEALS
47. Complaints
48. Appeal to Council
49. Appeal against decision of Registrar
50. Appeal Board
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
CHAPTER 11
JUDICIAL MATTERS
Application to High Court
Judicial management
Winding-up
Compromise
Information as to compromise
Appointment of curator
CHAPTER 12
GENERAL
General provisions on governance
Administration by intermediary
Charges by suppliers of service
Preservation of secrecy
Undesirable business practices
Limitation of liabili~
Amalgamation and transfer
Voluntary or automatic dissolution
Broker services and commission
Offences and penalties
Regulations
Repeal of laws and transitional arrangements
69. Short title and commencement
(Issue No 33- Supplementa~) 105
STATUTES OF THE REPUBLIC OF SOUTH AFWCA–MEDICWE, DENTISTRY AND P~ACY s. 1 Medical Schemes Act, No. 131 of 1998 s. 1
SCHEDULE 1
Laws repealed by section 68 (1)
SCHEDULE 2
Transitional provisions
CHAPTER 1
DEFmITIONS
1. Definitions.+ 1) In this Act, unless inconsistent with the context—
“actuary” means any fellow of an institute, faculty, society or chapter of actuaries approved by the Minister of Finance;
“administrator” means any person who has been accredited by the Council in terms of section 58, and shall, where any obligation has been placed on a medical scheme in terms of this Act, also mean a medical scheme;
“Appeal Board” means the Appeal Board established by section 50 (l);
“board of trustees” means the board of trustees charged with the managing of the affairs of a medical scheme, and which has been elected or appointed under its rules;
“business of a medical scheme” means the business of undertaking liability in return for a premium or contribution—
(a) to make provision for the obtaining of any relevant health service;
(b) to grant assistance in defraying expenditure incurred in connection with the rendering of any relevant health service; and
(c) where applicable, to render a relevant health service, either by the medical scheme itself, or by any supplier or group of suppliers of a relevant health ser- vice or by any person, in association with or in terms of an agreement with a medical scheme;
“Council” means the Council for Medical Schemes established by section 3;
“complaint” means a complaint of a. complainant relating to the administration of a medical scheme, the investment of its tids or the interpretation and application of its rules, and alleging—
(a) that a decision of the medical scheme or any person purportedly taken in terms of the rules was in excess of the powers of that medical scheme or person, or an improper exercise of its powers;
(b) that the complainant has sustained or may sustain prejudice in consequence of the maladministration of the medical scheme by the medical scheme or any per- son, whether by act or omission;
(c) that a dispute of fact or law has arisen in relation to the medical scheme between the medical scheme or any person and the complainant; or
(m that an employer who participates in the medical scheme has not filfilled its duties in terms of the rules of the medical scheme,
but shall not include a complaint which does not relate to a specific complainant;
(Issue No 33- Supp/ernenta~) 107
‘,-
s. 1 STATUTES OF THE WPUBLIC OF SOUTH AFWCA–MEDICmE, DENTISTRY AND PH~CY
Medical Schemes Act, No. 131 of 1998 s. 1
“curator” means a curator appointed under section 56;
“dependant” means—
(a) the spouse or partner, dependant children or other members of the member’s immediate family in respect of whom the member is liable for family care and support; or
(b) any other person who, under the rules of a medical scheme, is recognised as a dependant of such a member and is eligible for benefits under the rules of the medical scheme;
“financial year” means each period of 12 months endingon31 December;
“Master” means the Master of the High Court;
“medical scheme” means any medical scheme registered under section 24 (l);
“member” means a person who has been enrolled or admitted as a member of a medical scheme, or who, in terms of the rules of a medical scheme, is a member of such medical scheme;
“Minister” means the Minister of Health;
“officer” means any member of a board of trustees, any manager, principal officer, trea- surer, clerk or other employee of the medical scheme, but does not include the auditor of the medical scheme;
“prescribed” means prescribed by regulation;
“principal officern means the principal officer appointed in terms of section 57 (4) (a);
“Registrar” means the Registrar of Medical Schemes appointed in terms of section 18;
‘relevant health service~ means any health care treatment of any person by a person registered in terms of any law, which treatment has as its object—
(a)
(b)
(c)
(4
(e)
w
the physical or mental examination of that person;
the diagnosis, treatment or prevention of any physical or mental defect, ilhess or deficiency;
the givtig of advice in relation to any such defect, ilhess or deficiency;
the giving of advice in relation to, or treatment of, any condition arising out of a pregnancy, including the termination thereofi
the prescribing or supplying of any medicine, appliance or apparatus in relation to any such defect, ilhess or deficiency or a pregnancy, including the termina- tion thereoc or
nursing or midwife~,
and includes an ambulance service, and the supply of accommodation in an institution es- tablished or registered in terms of any law as a hospital, maternity home, nursing home or similar institution where nursing is practised, or any other institution where surgical or other medical activities are performed, and such accommodation is necessitated by any physical or mental defect, ilkess or deficiency or by a pregnancy;
(Issue No 33- Supplemenla~) 109
STATUTES OF THE REPUBLIC OF SOUTH AFWCA–MEDICINE, DENTISTRY AND PHAWACY SS.1–3 Medical Schemes Act, No. 131 of 1998 SS.1–3
“restricted membership scheme” means a medical scheme, the rules of which restrict the eligibility for membership by reference t~
(a) emplo~ent or former employment or both employment or former employment in a profession, trade, industry or calling;
(b) employment or former employment or both employment or former employment by a particular employer, or by an employer included in a particular class of employers;
(c) membership or former membership or both membership or former membership of a particular profession, professional association or union; or
(~ any other prescribed matter;
“rules” means the rules of a medical scheme and include—
(a) the provisions of the law, charter, deed of settlement, memorandum of associa- tion or other document by which the medical scheme is constituted;
(b) the articles of association or other rules for the conduct of the business of the medical scheme; and
(c) the provisions relating to the benefits which maybe granted by and the contri- butions which may become payable to the medical scheme;
“this Act” includes the regulations.
(2) For the purposes of this Act any reference in this Act to a medical scheme shall be construed as a reference to that medical scheme or to the board of trustees of that medical scheme, as the case may be.
C~PTER 2
APPLICATION OF ACT
2. Application of Act.+ 1) If any conflict, relating to the matters dealt within this Act, arises bemeen this Act and the provisions of any other law save the Constitution or any Act expressly amending this Act, the provisions of this Act shall prevail.
(2) This Act shall also apply to a medical scheme established by any organ of the State including those medical schemes established under section 28 (g) of the Labour Relations Act, 1995 (Act No. 66 of 1995).
CWTER 3
COUNCIL FOR MEDICAL SCHEMES
Part 1: Council
3. Establishment of Council for Medical Schemes.-( 1) There is hereby established a juristic person called the Council for Medical Schemes.
(2) The Councd shall be entitled to sue and be sued, to acquire, possess and alienate moveable and immovable property and to acquire rights and incur liabilities.
(3) The registered office of the Council shall be situated in Pretoria or such other address as the Council may from time to time determine.
(4) The Council shall, at all times, finction in a transparent, responsive and efficient manner.
(Issue No 33- Supplemen?u~) 111
STATUTES OF THE REPUBLIC OF SOUTH AFWCA–MEDICNE, DENTISTRY AND P~ACY SS.4–7 Medical Schemes Act, No. 131 of 1998 SS.4–7
4. Constitution of Council.