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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

15F. Capitation agreements


A medical scheme shall not enter into a capitation agreement, unless –

a) the agreement is in the interests of the members of the medical scheme;
b) the agreement embodies a genuine transfer of risk from the medical scheme to the managed health care organisation;
c) the capitated payment is reasonably commensurate with the extent of the risk transfer.