MEDICAL SCHEMES ACT NO. 131 OF 1998

Download Complete PDF MEDICAL SCHEMES ACT 131 OF 1998
REGULATIONS

GNR.1262 of 20 October 1999: Regulations
DEPARTMENT OF HEALTH
as amended by

Notice

Government Gazette

Date

R.570
R.650

R.247

R.1360

1397

R.1410

21256
21313
23193
24007
25537
27055

5 June 2000
30 June 2000
1 March 2002
4 November 2002
6 October 2003
3 December 2004


The Minister of Health has, in terms of section 67 of the Medical Schemes Act, 1998 (Act No. 131 of 1998), after consultation with the Council for Medical Schemes, made the regulations in the Schedule.
M.E. TSHABALALA MSIMANG
Minister of Health


SCHEDULE
ARRANGEMENT OF REGULATIONS
CHAPTER 1 DEFINITIONS

1. Definitions


CHAPTER 2 ADMINISTRATIVE REQUIREMENTS
2. Registration of medical scheme
3. Proof of membership
4. Administration of a medical scheme
5. Accounts by suppliers of services
6. Manner of payment of benefits
6A. Disclosure of trustee remuneration


CHAPTER 3 CONTRIBUTIONS AND BENEFITS
7. Definitions
8. Prescribed Minimum Benefits
9. Limits on benefits
9A. Non-accumulation of benefits
9B. Contributions in respect of dependants
10. Personal medical savings accounts


CHAPTER 4 WAITING PERIODS AND PREMIUM PENALTIES
11. Definitions
12. Medical reports
13. Premium penalties for persons joining late in life
14. . . . . . .


CHAPTER 5 PROVISION OF MANAGED HEALTH CARE
15. Definitions
15A. Prerequisites for managed health care arrangements
15B. Accreditation of managed health care organisations
15C. Suspension or withdrawal of accreditation
15D. Standards for managed health care
15E. Provision of health services
15F. Capitation agreements
15G. Limitation on disease coverage
15H. Protocols
15I. Formularies
15J. General provisions


CHAPTER 6 ADMINISTRATORS OF MEDICAL SCHEMES

16.
17. Accreditation of administrators
17A. Suspension or withdrawal of accreditation
18. Agreement in respect of administration
19. Termination of administration agreements
20. Appointment of auditor
21. Indemnity and fidelity guarantee insurance
22. Maintenance of financially sound condition
23. Depositing of medical scheme moneys
24. Safe custody of documents of title
25. Annual report
26. Furnishing of other information
27. Ceasing, dissolution or liquidation of business


CHAPTER 7 CONDITIONS TO BE COMPLIED WITH BY BROKERS

28. Compensation of brokers
28A. Admission of members to a medical scheme
28B. Accreditation of brokers
28C. Suspension or withdrawal of accreditation


CHAPTER 8 ACCUMULATED FUNDS AND ASSETS

29. Minimum accumulated funds to be maintained by a medical scheme
30. Limitation on assets


CHAPTER 9 GENERAL MATTERS
31. Fees payable
32. Penalties
33. Commencement of the regulations


Annexure A

Prescribed Minimum Benefits
Annexure B

Limitation on assets
Annexure C

Audit reports for the purposes of Regulation 25
Annexure D

Management representation letter for the purposes of Regulation 25

 


CHAPTER 1 DEFINITIONS
1. Definitions.—In these Regulations any expression defined in the Act bears that meaning and, unless the context otherwise indicates—

 

"broker" . . . . . .
[Definition of "broker" deleted by GNR.1360 of 2002 wef 1 January 2003.]

 

"child dependant" means a dependant who is under the age of 21 or older if he or she permitted under the rules of a medical scheme to be a dependant;

 

"creditable coverage" . . . . . .
[Definition of "creditable coverage" deleted by GNR.1360 of 2002 wef 1 January 2003.]

 

"enhanced option" . . . . . .
[Definition of "enhanced option" deleted by GNR.1360 of 2002 wef 1 January 2003.]

 

"hospital treatment" . . . . . .
[Definition of "hospital treatment" deleted by GNR.1360 of 2002 wef 1 January 2003.]

 

"late joiner" . . . . . .
[Definition of "late joiner" deleted by GNR.1360 of 2002 wef 1 January 2003.]

 

"managed health care" . . . . . .
[Definition of "managed health care" deleted by GNR.1360 of 2002 wef 1 January 2003.]

 

"practice code number" means the number allotted to a supplier of a relevant health service as a practice number by an organisation or body approved by the Council;

 

"pre-existing sickness condition" . . . . . .
[Definition of "pre-existing sickness condition" deleted by GNR.1360 of 2002 wef 1 January 2003.]

 

"public hospital system" . . . . . .
[Definition of "public hospital system" deleted by GNR.1360 of 2002 wef 1 January 2003.]

 

"the Act" means the Medical Schemes Act, 1998 (Act No. 131 of 1998).

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