BHF will appeal benefits judgment

Believes the judgment is bad news for consumers.

The Board of Healthcare Funders (BHF) will appeal against a court ruling that requires medical aids to pay in full for prescribed minimum benefits’ (PMB) conditions.

“The BHF believes the judgment is bad news for consumers, as the uncertainty with regards to pricing of healthcare will continue,” it said in a statement on Thursday.

On Monday, the High Court in Pretoria ruled that PMBs, which protect members of medical schemes, must remain in place.

The BHF was one of the respondents in the case.

It was hoping the court would give a clear understanding of the implications of regulation eight of the Medical Schemes Act 131 of 1998.

The regulation states that medical schemes must pay for the diagnosis, treatment and care of all PMB conditions in full, or at the price charged by the health care provider.

Therefore, private healthcare providers, could for example, inflate their prices with the knowledge that it exceeded costs that might be incurred by government hospitals, clinics and the like.

The industry body said it would appeal the ruling as the principles and merits of the matter did not appear to have been considered.

“We believe that this judgment may negatively affect the sustainability of medical schemes, which have been under severe financial pressure due to the opportunistic and reckless charging by some healthcare providers for PMB.”

It said it was concerned that medical schemes may have no choice but to raise contribution premiums and this would affect its members.

“Over the past few years, the healthcare provider fraternity has been partly or fully responsible for the scrapping of all healthcare pricing guidelines and undermining the coding structure.”

This had increased costs within the private healthcare sector.

“We believe that the judgment will allow this untenable situation to continue,” said the BHF.





About Medinol:
Medinol is one of the few purpose-built practice management application to meet the unique needs of independent private healthcare providers. Today Medinol helps over 130 providers throughout South Africa run more efficient and profitable practices, while delivering outstanding patient care. As an on-premise software, Medinol and the data it manages, is fully under your control. This enhances your independence and privacy: what happens in your rooms, stays in your rooms. Medinol helps manage your patient information, generates your billings, submits your claims, control your outstandings, and get your accounts paid quickly. Medinol has been in operation since 1984 demonstrating its proven efficacy. Medinol’s mission is to help independent practices succeed in an ever-changing healthcare environment. More information can be found at


medical billing software


Fudley Bezuidenhout Pr.Eng.
Founder and CEO
Ph: 021-906-2296
Cell: 082-688-9610


Leave a Reply

Your email address will not be published. Required fields are marked *