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Table of Contents
Medical Schemes Act, 1998 (Act No. 131 of 1998)
Notice No. 1559 of 1998
Act
Chapter 1 : Definitions
1. Definitions
Chapter 2 : Application of Act
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
17. Liquidation
Part 2 : Registrar, Deputy 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"
21A. Marketing
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
29A. Waiting periods
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
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
Chapter 11 : Judicial Matters
51. Application to High Court
52. Judicial Management
53. Winding-up
54. Compromise
55. Information as to Compromise
56. Appointment of Curator
Chapter 12 : General
57. General Provisions on Governance
58. Administration by Intermediary
59. Charges by Suppliers of Service
60. Preservation of Secrecy
61. Undesirable Business Practices
62. Limitation of Liability
63. Amalgamation and Transfer
64. Voluntary or Automatic Dissolution
65. Broker Services and Commission
66. Offences and Penalties
67. Regulations
68. Repeal of Laws, and Transitional Arrangements
69. Short Title and Commencement
Schedules
Schedule 1 : Laws Repealed by section 68(1)
Laws Repealed by section 68(1)
Schedule 2 : Transitional Arrangements
1. Council for Medical Schemes
2. Assets and liabilities
3. Transfer of officers and employees
4. Medical Schemes
5. Reinsurance contracts
6. Principal officers
Regulations
Regulations in terms of the Medical Schemes Act, 1998
Notice No. R. 1262 of 1999
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. General waiting periods
12. Medical Reports
13. Premium penalties for persons joining late in life
14. Continued membership
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. Administrators of medical schemes
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
32A. Value added tax
33. Commencement of the regulations
Annexures
Annexure A
Introduction
Brain and Nervous System
Eye
Ear, Nose, Mouth and Throat
Respiratory System
Heart and Vasculature
Gastro-Intestinal System
Liver, Pancreas and Spleen
Musculoskeletal System: Trauma Nos
Skin and Breast
Endocrine, Metabolic and Nutritional
Urinary and Male Genital System
Female Reproductive System
Pregnancy and Childbirth
Haematological, Infectious and Miscellaneous Systemic Conditions
Mental Illness
Explanatory notes and definitions to Annexure A
Chronic Conditions
Amendment Therapeutic Algorithms for Chronic Conditions
Annexure B
Annexure B : Limitation on assets to be held in the Republic
Annexure B : Explanatory notes and conditions for Annexure B
Annexure C : Independent Auditors Report template
Annexure D : Management Representation Letter template
Notices
Appointment of the Chairperson and Members of the Council for Medical Schemes
Notice No. 2211 of 1999
Notice of Intention to Publish Undesirable Business Practice Declaration in terms of Section 61(2)
Notice No. 643 of 2004
Adjustment to Fees Payable to Brokers - 2018
Notice No. 1253 of 2017
Adjustment to Fees Payable to Brokers - 2019
Notice No. 30 of 2019
Registered Medical Schemes 2019
Notice No. 71 of 2019
Adjustment to Fees Payable to Brokers - 2020
Notice No. 24 of 2020
[Replaced] Registered Medical Schemes 2021
Notice No. 74 of 2021
Adjustment to Fees Payable to Brokers - 2021
Notice No. 206 of 2021
Declaration of certain practices by Medical Schemes in selecting designated Health Care Providers and imposing excessive co-payments on members as irregular or undesirable practices by the Medical Schemes, in terms of Section 61 of the Medical Schemes Act
Notice No. 214 of 2021
Registered Medical Schemes 2022
Notice No. 880 of 2022
Adjustment to Fees Payable to Brokers - 2022
Notice No. 881 of 2022
Adjustment to Fees Payable to Brokers - 2023
Notice No. 1629 of 2023
Adjustment to Fees Payable to Brokers - 2024
Notice No. 2288 of 2024
"Minister"
means the Minister of Health.
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