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Medical Schemes Act, 1998 (Act No. 131 of 1998)


Regulations in terms of the Medical Schemes Act

Chapter 5 : Provision of managed health care

15B. Accreditation of managed health care organisations


1) Any person desiring to be accredited as a managed health care organisation must apply in writing to the Council.


2) An application for accreditation as a managed health care organisation must be accompanied by –
a) the full name and curriculum vitae of the person who is the head of the managed health care organisation's business;
b) the home and business address and telephone numbers of the person referred to in paragraph (a);
c) a copy of the proposed managed health care agreement or agreements between the managed health care organisation and the medical scheme or medical schemes concerned; and
d) such information as the Council may deem necessary to satisfy it that such person –
i) is fit and proper to provide managed health care services;
ii) has the necessary resources, systems, skills and capacity to render the managed health care services which it wishes to provide; and
iii) is financially sound.


3) In considering an application for accreditation in terms of this regulation, the Council may take into consideration any other information regarding the applicant, derived from whatever source, if such information is disclosed to the applicant and she or he is given a reasonable opportunity to respond thereto.


4) The Council must, after consideration of an application –
a) if satisfied that an applicant meets the criteria listed in items (i),(ii) and (iii) of subregulation (2)(d), grant the application subject to any conditions that it may deem necessary; or
b) if not so satisfied, refuse the application and provide reasons to the applicant for such refusal.


5) If accreditation is granted by the Council in terms of subregulation (4)(a), it shall be granted for twenty-four months, and shall be accompanied by a certificate from the Registrar clearly specifying the expiry date of the accreditation and any conditions imposed by the Council in terms of subregulation (4)(a).


6) The Council may at any time after the issue of a certificate of accreditation, on application by a managed health care organisation or on own initiative add, withdraw or amend any condition or restriction in respect of the accreditation, after having given the relevant managed health care organisation a reasonable opportunity to make submissions on the proposed addition, withdrawal or amendment and having considered those submissions, if the Council is satisfied that any such addition, withdrawal or amendment is justified and will not unfairly prejudice the interests of the clients of the managed health care organisation, and must in every such case issue an appropriately amended certificate to the managed health care organisation.


7) A person wishing to renew accreditation as a managed health care organisation shall apply to the Council for such renewal in such format as the Council may from time to time determine, provided that –
a) such application for renewal shall be made at least three months prior to the date of expiry of the accreditation; and
b) such person shall furnish the Council with any information that the Council may require.


8) The provisions of subregulations (4) to (6) shall apply mutatis mutandis to an application for renewal of accreditation in terms of subregulation (7)