During the latest case of the Board of Healthcare Funders of Southern Africa v Council For Medical Schemes 2011 JDR 1471 (GNP), the first and second applicants approached a legal court by way of a request to release a declaratory order regarding the explanation of the phrase "pay in full" in regulation 8(1) of the General Regulations made pursuant towards the Healthcare Schemes Act, 131 of 1998.
The candidates put forward the proposition that the Court needed to determine three concerns, which is: 1. The first applicant's entitlement to commence procedures for declaratory aid; 2. The interest and locus standi of the intervening participants in opposing the relief wanted by way of the applicants; and 3. The meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations that had been promulgated in terms of area 67 of the Act.
Regulation 8 has been in force since 1 January 2000. In accordance with the applicants, the current problem begun on 11 November 2008 once the Appeal Board resolved two cases on appeal which was forwarded from the Appeal Committee in terms of section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to these two judgements, considered the phrase "pay in full" in regulation 8 to indicate that the medical scheme should effect full payment of the service providers' invoice in respect of the charges of offering healthcare services for Prescribed Minimum Benefits if you don't take the rules of the health care scheme into consideration in dealing with any grievances.
It had been the applicants' contention that "pay in full" indicates payment according to the policies of the Healthcare Scheme, while according to the participants, the judgements by the Appeal Board have not been challenged as yet and presently medical aid schemes are bound to this authority and still have to repay service providers' invoices fully.
The principle gripe by the participants was that the first applicant had no immediate and significant interest in the application since the verdict will not have an effect on it. Although the first candidate suggested it defended 75 licensed professional medical aid schemes and therefore had locus standi, the judge identified this to not be. This was due to the fact that the first candidate saw fit to have the second candidate, who is a registered medical aid scheme, amalgamated. Moreover, only 15 registered professional medical schemes, in the starting and supplementary founding affidavits, affirmed that a declaratory order needs to be sought.
A Legal Court held that had the initial candidate been so sure that it represented all 75 medical aid schemes it wouldn't have been necessary to join the other applicant or to get hold of affidavits and signatures of 15 members of the first candidate. The Judge came to the conclusion from this that the first applicant did not in reality represent 75 members, but only the 15 members pointed out inside the paperwork.
The non-joinder of all of the healthcare schemes made the application fatally defective as the Judge couldn't discover that the 1st candidate, as a standard representative of the professional medical schemes, could be prejudicially impacted by a ruling, but learned that its members may be prejudicially impacted and accordingly, many of the participants should have jointly instituted the request for any declaratory order.
The Judge found that the initial applicant didn't have locus standi for the following reasons:
1. The issue was one that could be considered a representative issue, but not every one of the medical schemes had been combined and it has not been started as a representative matter because of the fact that the first applicant did not have any authority to litigate on behalf of all 75 of their associates;
2. In order to commence action in terms of Section 38 in the Constitution, a litigant should demonstrate that the right enshrined in the Bill of Rights may be encroached upon along with adequate interest in the relief sought. The 1st applicant didn't clearly aver such infringement and the Court found out that the First Litigant wouldn't be directly affected by the judgment and didn't have a satisfactory concern in the relief sought.
Regarding the other applicant the court held it will not succeed in the application on its own, as not one of the alternative professional medical aid schemes or administrators have been coupled.
The candidates put forward the proposition that the Court needed to determine three concerns, which is: 1. The first applicant's entitlement to commence procedures for declaratory aid; 2. The interest and locus standi of the intervening participants in opposing the relief wanted by way of the applicants; and 3. The meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations that had been promulgated in terms of area 67 of the Act.
Regulation 8 has been in force since 1 January 2000. In accordance with the applicants, the current problem begun on 11 November 2008 once the Appeal Board resolved two cases on appeal which was forwarded from the Appeal Committee in terms of section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to these two judgements, considered the phrase "pay in full" in regulation 8 to indicate that the medical scheme should effect full payment of the service providers' invoice in respect of the charges of offering healthcare services for Prescribed Minimum Benefits if you don't take the rules of the health care scheme into consideration in dealing with any grievances.
It had been the applicants' contention that "pay in full" indicates payment according to the policies of the Healthcare Scheme, while according to the participants, the judgements by the Appeal Board have not been challenged as yet and presently medical aid schemes are bound to this authority and still have to repay service providers' invoices fully.
The principle gripe by the participants was that the first applicant had no immediate and significant interest in the application since the verdict will not have an effect on it. Although the first candidate suggested it defended 75 licensed professional medical aid schemes and therefore had locus standi, the judge identified this to not be. This was due to the fact that the first candidate saw fit to have the second candidate, who is a registered medical aid scheme, amalgamated. Moreover, only 15 registered professional medical schemes, in the starting and supplementary founding affidavits, affirmed that a declaratory order needs to be sought.
A Legal Court held that had the initial candidate been so sure that it represented all 75 medical aid schemes it wouldn't have been necessary to join the other applicant or to get hold of affidavits and signatures of 15 members of the first candidate. The Judge came to the conclusion from this that the first applicant did not in reality represent 75 members, but only the 15 members pointed out inside the paperwork.
The non-joinder of all of the healthcare schemes made the application fatally defective as the Judge couldn't discover that the 1st candidate, as a standard representative of the professional medical schemes, could be prejudicially impacted by a ruling, but learned that its members may be prejudicially impacted and accordingly, many of the participants should have jointly instituted the request for any declaratory order.
The Judge found that the initial applicant didn't have locus standi for the following reasons:
1. The issue was one that could be considered a representative issue, but not every one of the medical schemes had been combined and it has not been started as a representative matter because of the fact that the first applicant did not have any authority to litigate on behalf of all 75 of their associates;
2. In order to commence action in terms of Section 38 in the Constitution, a litigant should demonstrate that the right enshrined in the Bill of Rights may be encroached upon along with adequate interest in the relief sought. The 1st applicant didn't clearly aver such infringement and the Court found out that the First Litigant wouldn't be directly affected by the judgment and didn't have a satisfactory concern in the relief sought.
Regarding the other applicant the court held it will not succeed in the application on its own, as not one of the alternative professional medical aid schemes or administrators have been coupled.
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