SUPREME COURT OF APPEAL
RULES IN FAVOUR OF THE REGISTRAR OF MEDICAL SCHEMES ON OMNI-HEALTH


The Supreme Court of Appeal has ruled in favour of the Registrar of Medical Schemes and refused an application for leave to
INVITATION Risk Equalisation Workshop:
Guidelines for the Identification of Beneficiaries with REF Risk Factors in Accordance with the REF Entry and Verification Criteria.



The Council for Medical Schemes invites interested parties to a one-
appeal by liquidators of the defunct Omnihealth medical schemes.

On 30 January 2007, the Registrar obtained an order in the Pretoria High Court compelling the Omnihealth liquidators to pay the R33 million of medical savings accounts back to Omnihealth members. Since then, they have made attempts to have the ruling reversed, first by lodging a leave to appeal with Transvaal Provincial High Court, then with Bloemfontein Supreme Court of Appeal. Both appeals were dismissed with costs.

In the decision handed down on the 30 January, Judge J du Plessis found in favor of the Registrar and maintained that Omnihealth's rules, which serve as an agreement between the member and the scheme, stated that the balances in the PMSA shall at all times remain the property of the member. These moneys should either paid to the next scheme that also has the PMSA or paid in cash back to the members

The learned judge made the following order:
- That the credit balances in the Omni health personal medical savings accounts constitute trust money per provisions of Protection of the Funds Act (Financial Institutions Act, Act 28 of 2001);

- The liquidators of Omni health should pay to KwaZulu Natal Medical Scheme such portion of PMSA funds, including interest that has accrued, to Omni health members who joined KZN Medical Scheme;

- The liquidators should pay such portion and interest to former members of Omnihealth who did not become members of KZN Medical Scheme. These payments have to be effected within 60 days of the issuing of the order; and

- The liquidators were also ordered to pay the Registrar's costs, which shall include costs of two counsels.

Commenting on the Supreme Court of Appeal decision, Registrar of Medical Schemes, T. Patrick Masobe, called on the liquidators to stop being equivocal and pay the money to the former Omni-health members immediately. Masobe said that the former Omni-health members should have been refunded their medical savings accounts balances many months ago; there should be no further delays.

"The legal challenge by the liquidators was incongruous with their responsibility towards the former members of Omnihealth. This Supreme Court decision is now the end of the line; they now have to do the right thing and pay out these money without any further delays," says Masobe.

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Previous Related Publications:
Registrar Of Medical Schemes Wins Back R33 Million for Members of Omnihealth
day workshop on 15 June 2007 on the 'Guidelines for the Identification of Beneficiaries with REF Risk Factors in Accordance with the REF Entry and Verification Criteria'.
The workshop will focus on three areas, including the current contents of the guidelines, how to implement these guidelines at an operational - technical level, and a discussion around possible changes to the guidelines that will become operative in 2008.

To effect the above:
  1. Please submit comments on the existing guidelines (Version 2.1) and suggestions that could be considered for incorporation in the next Version of the guidelines by 18 May 2007.
  2. Please RSVP to Lerato Kgori per l.kgori@medicalschemes.com by 18 May 2007. It might be necessary to limit the number of people that could be accommodated
Based on the response a venue will be finalised and a final programme distributed

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Previous Related Publications:

Completion of REF Study 2005, Implications for REF Definitions and Dates for REF Grid Submission in 2007

Publication of the Report on Quarter 4 - 2005 to Quarter 2 - 2006 Shadow REF Submissions

Guidelines for the Identification of Beneficiaries with REF Risk Factors in Accordance with the REF Entry and Verification Criteria: Version 2.1


Know Your Rights: Prescribed Minimum Benefits Summary Document Published:

The The Prescribed Minimum Benefits Summary document has been published on the CMS website for both consumers and providers. The summary includes Diagnosis and Treatment Pairs (DTP) and CDL Codes.

To view this Publication: Click Here

OTHER RECENT CMS PUBLICATIONS

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