Medical Schemes Act [No. 131 of 1998] - SAFLII Home

1 STATUTES OF THE REPUBLIC OF SOUTH AFRICA MEDICmE, DENTISTRY AND PHAWACYMEDICAL Schemes ACTNO. 131 OF 1998[ASSENTED TO 20 NOVEMBER, 1998][DATE OF COMMENCEMENT TO BE PROCLAIMED](English text signed by the President)ACTTo 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 theappointment of the Registrar of Medical Schemes ; to make provision for the registrationand control of certain activities of Medical Schemes ; to protect the interests of members ofmedical Schemes ; to provide for measures for the co-ordination of Medical Schemes ; andto provide for incidental OF ACTCHAPTER 1 DEF~ITIONS1.

2 Definitions2. Application of ActCHAPTER 2 APPLICATION OF ACTCHAPTER 3 COUNCIL FOR Medical SCHEMESPart 1: Council3. Establishment of Council for Medical Schemes4. Constitution of Council5. Disqualification as member of Council, and vacation of office6. Term of office of member of Council7. Functions of Council8. Powers of Council9. Committees of Council10. Meetings of Council11. Remuneration of members of Council and committees12. Funds of Council13. Accounting officer14. Annual report15. Consultation between Minister and Council16. Cases of improper or disgraceful (Issue No 33- Supplemenfav)101 STATUTES OF THE REPUBLIC OF SOUTH AFWCA MEDIC~, DENTISTRY AND PHARMACYM edical Schemes Act, No.

3 131 of 199817. LiquidationPart 2: Registrar, Depu@ Registrar and staff of Council18. Appointment of Registrar and Deputy Registrar of Medical Schemes19. Staff of CouncilCHAPTER 4 Medical SCHEMES20. Business of Medical scheme21. Use of designation Medical scheme 22. Application for registration23. Name of Medical scheme and change of name24. Registration as Medical scheme25. Notification of registration26. Effect of registration27. Cancellation and suspension of registration28. Prohibition of membership of, and claims against, more than one Medical schemeCHAPTER 5 RULES OF Medical SCHEME29. Matters for which rules shall provide30. General provisions to be contained in rules31.

4 Amendment of rules32. Binding force of rulesCHAPTER 6 BENEFIT OPTIONS33. Approval and withdrawal of benefit options34. Prohibition on cession and attachment of benefitsCHAPTER 7 FINANCIAL MATTERS35. Financial arrangements36. Auditor and audit committee37. Annual financial statements38. Registrar may reject returnsCHAPTER 8 DOCUMENTS39. Requirements in regard to documents to be deposited with Registrar40. Effect of Registrar s certificate on documents41. 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 PHAWACYM edical Schemes Act, No. 131 of 1998 CHAPTER 9 POWERS OF REGISTRAR42.

5 Registrar may require additional particulars43. Enquiries by Registrar44. Inspections and reports45. Persons not registered to furnish information46. Removal of member of board of trusteesCHAPTER 10 COMPLAINTS AND APPEALS47. Complaints48. Appeal to Council49. Appeal against decision of Registrar50. Appeal 11 JUDICIAL MATTERSA pplication to High CourtJudicial managementWinding-upCompromiseInformatio n as to compromiseAppointment of curatorCHAPTER 12 GENERALG eneral provisions on governanceAdministration by intermediaryCharges by suppliers of servicePreservation of secrecyUndesirable business practicesLimitation of liabili~Amalgamation and transferVoluntary or automatic dissolutionBroker services and commissionOffences and penaltiesRegulationsRepeal of laws and transitional arrangements69.

6 Short title and commencement(Issue No 33- Supplementa~)105 STATUTES OF THE REPUBLIC OF SOUTH AFWCA MEDICWE, DENTISTRY AND P~ACYs. 1 Medical Schemes Act, No. 131 of 1998s. 1 SCHEDULE 1 Laws repealed by section 68 (1)SCHEDULE 2 Transitional provisionsCHAPTER 1 DEFmITIONS1. Definitions.+ 1) In this Act, unless inconsistent with the context actuary means any fellow of an institute, faculty, society or chapter of actuariesapproved by the Minister of Finance; administrator means any person who has been accredited by the Council in terms ofsection 58, and shall, where any obligation has been placed on a Medical scheme in terms ofthis 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 affairsof a Medical scheme, and which has been elected or appointed under its rules.

7 Business of a Medical scheme means the business of undertaking liability in return fora 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 therendering of any relevant health service; and(c) where applicable, to render a relevant health service, either by the medicalscheme 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 amedical scheme; Council means the Council for Medical Schemes established by section 3; complaint means a complaint of a.

8 Complainant relating to the administration of amedical 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 termsof the rules was in excess of the powers of that Medical scheme or person, or animproper exercise of its powers;(b) that the complainant has sustained or may sustain prejudice in consequence ofthe 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 betweenthe Medical scheme or any person and the complainant; or(m that an employer who participates in the Medical scheme has not filfilled itsduties 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.)

9 1 STATUTES OF THE WPUBLIC OF SOUTH AFWCA MEDICmE, DENTISTRY AND PH~CYMedical Schemes Act, No. 131 of 1998s. 1 curator means a curator appointed under section 56; dependant means (a) the spouse or partner, dependant children or other members of the member simmediate family in respect of whom the member is liable for family care andsupport; or(b) any other person who, under the rules of a Medical scheme, is recognised as adependant of such a member and is eligible for benefits under the rules of themedical 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).

10 Member means a person who has been enrolled or admitted as a member of a medicalscheme, or who, in terms of the rules of a Medical scheme, is a member of such medicalscheme; 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 themedical 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 personregistered in terms of any law, which treatment has as its object (a)(b)(c)(4(e)wthe physical or mental examination of that person;the diagnosis, treatment or prevention of any physical or mental defect, ilhessor deficiency;the givtig of advice in relation to any such defect, ilhess or deficiency.)