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SCA confirms that Genesis Medical Scheme has to pay for prescribed minimum benefits in full for treatment obtained at a private medical facility

27 November 2015
– 1 Minute Read


The long awaited judgment in the matter between The Council for Medical Schemes v Genesis Medical Scheme (20518/14) [2015] ZASCA 161 was handed down by the Supreme Court of Appeal (SCA) on 16 November 2015. The court confirmed that medical schemes which have not appointed designated service providers (DSPs) will be liable in full for the cost of prescribed minimum benefits (PMBs). This is regardless of whether treatment is obtained at a public or private medical facility and even if the scheme’s rules say the State is the designated healthcare provider for PMBs.