Masterclass 1: Navigating Medical Schemes
Overview
The first Healthcare Law & Policy Masterclass focused on the legal, regulatory and operational dimensions of medical schemes in South Africa. Through presentations by leading experts in healthcare and insurance law, participants explored the legislative framework governing medical schemes, the practical implications of governance structures, and the rights and responsibilities of members and administrators.
The session examined how regulatory requirements shape scheme administration while balancing affordability, sustainability and equitable access to healthcare funding.
Key Topics Covered
The Medical Schemes Act
The masterclass provided an overview of the Medical Schemes Act 131 of 1998, highlighting its role in regulating medical schemes, protecting members and promoting fair access to healthcare funding mechanisms.
Scheme Governance
Presenters explored governance structures within medical schemes, discussing accountability, fiduciary responsibilities, regulatory compliance and the role of trustees and administrators in ensuring effective scheme management.
Open versus Restricted Enrolment
Participants examined the distinctions between open and restricted medical schemes and how membership rules influence accessibility and risk management within schemes.
Community Rating versus Risk Rating
The session considered the principles of community rating and risk rating, analysing their implications for fairness, affordability and sustainability in healthcare financing.
Waiting Periods and Late Joiner Penalties
Experts discussed the policy rationale underpinning waiting periods and late joiner penalties, addressing how these mechanisms seek to prevent adverse selection and maintain the viability of medical schemes.
Dispute Resolution Mechanisms
The masterclass concluded with a discussion on both regulatory and internal dispute resolution processes available to members and medical schemes.
Presenters
David Geral
Partner, Financial Services Regulatory Practice, Bowmans
Neil Kirby
Director and Head of Healthcare Services, Werksmans Inc.
Howard Snoyman
Head of Legal and Ethics, Discovery Health Medical Scheme
Facilitator
Prof Jonathan Klaaren
Professor of Law & Society, University of the Witwatersrand
The masterclass took place on 13 March 2025.