During the latest matter of the Board of Healthcare Funders of Southern Africa v Council For Medical Schemes 2011 JDR 1471 (GNP), the first and second applicants approached the judge with a petition to give out a declaratory order regarding the explanation of the words "pay in full" in regulation 8(1) of the General Regulations made pursuant for the Medical Schemes Act, 131 of 1998.
The applicants put forward the proposition that the Court had to determine three issues, namely: 1. The first applicant's entitlement to initiate procedures for declaratory relief; 2. The interest and locus standi of the intervening participants in opposing the relief wanted by the applicants; and 3. The meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations that had been promulgated with respect to area 67 of the Act.
Regulation 8 has been in force since 1 January 2000. As reported by the applicants, the actual problem started on 11 November 2008 once the Appeal Board decided two cases on appeal which were forwarded by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to these two decisions, interpreted the words "pay in full" in regulation 8 to signify that the healthcare scheme need to effect 100 % repayment of a service providers' bill in respect of the fees of delivering heath care treatment services for Prescribed Minimum Benefits if you don't take the guidelines of the professional medical scheme into account in working with any problems.
It was the applicants' contention that "pay in full" implies repayment according to the regulations of the Professional medical Scheme, while in accordance with the respondents, the decisions by the Appeal Board have not been challenged as yet and presently professional medical aid schemes are bound to this power while having to pay for service providers' accounts completely.
The principle gripe via the participants could be that the first applicant didn't have immediate and substantial interest in the application since the verdict will not have a direct impact on it. Although the first applicant suggested it defended 75 registered medical aid schemes and therefore had locus standi, the Court discovered this not to be. This was due to the fact that the first candidate saw suitable to have the second applicant, who's an authorized healthcare aid scheme, amalgamated. In addition, only 15 registered professional medical schemes, within the founding and extra founding affidavits, confirmed that a declaratory order should be sought.
A Legal Court held that had the initial candidate been so certain that it represented all 75 medical aid schemes it would not have been necessary to join the second applicant or to receive affidavits and signatures of 15 members of the primary candidate. The Court concluded out of this that the first candidate did not in reality legally represent 75 members, but only the 15 members talked about within the papers.
The non-joinder of all of the medical schemes made the application fatally defective as the Courts couldn't find that the 1st applicant, as being a general representative of the medical schemes, would be prejudicially affected by a judgment, but discovered that its participants may all be prejudicially impacted and accordingly, all the participants should have jointly instituted the application for any declaratory order.
The Judge found that the first applicant was lacking locus standi for the following reasons:
1. The matter was one which may be classified as a representative matter, although not every one of the healthcare schemes had been amalgamated and it had not been launched as a representative topic due to the fact that the first applicant didn't have any authority to litigate on the part of all 75 of their members;
2. In order to institute action with respect to Section 38 of the Constitution, a litigant must demonstrate that a right enshrined inside the Bill of Rights has been encroached upon along with satisfactory interest in the relief wanted. The primary candidate didn't clearly aver any such encroachment and the Judge found out that the primary Litigant wouldn't be directly influenced by the judgment and was lacking an acceptable interest in the relief sought.
With respect to the second applicant the judge held it will not be successful in the application by itself, as not one of the other medical aid schemes or managers ended up being joined.
The applicants put forward the proposition that the Court had to determine three issues, namely: 1. The first applicant's entitlement to initiate procedures for declaratory relief; 2. The interest and locus standi of the intervening participants in opposing the relief wanted by the applicants; and 3. The meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations that had been promulgated with respect to area 67 of the Act.
Regulation 8 has been in force since 1 January 2000. As reported by the applicants, the actual problem started on 11 November 2008 once the Appeal Board decided two cases on appeal which were forwarded by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to these two decisions, interpreted the words "pay in full" in regulation 8 to signify that the healthcare scheme need to effect 100 % repayment of a service providers' bill in respect of the fees of delivering heath care treatment services for Prescribed Minimum Benefits if you don't take the guidelines of the professional medical scheme into account in working with any problems.
It was the applicants' contention that "pay in full" implies repayment according to the regulations of the Professional medical Scheme, while in accordance with the respondents, the decisions by the Appeal Board have not been challenged as yet and presently professional medical aid schemes are bound to this power while having to pay for service providers' accounts completely.
The principle gripe via the participants could be that the first applicant didn't have immediate and substantial interest in the application since the verdict will not have a direct impact on it. Although the first applicant suggested it defended 75 registered medical aid schemes and therefore had locus standi, the Court discovered this not to be. This was due to the fact that the first candidate saw suitable to have the second applicant, who's an authorized healthcare aid scheme, amalgamated. In addition, only 15 registered professional medical schemes, within the founding and extra founding affidavits, confirmed that a declaratory order should be sought.
A Legal Court held that had the initial candidate been so certain that it represented all 75 medical aid schemes it would not have been necessary to join the second applicant or to receive affidavits and signatures of 15 members of the primary candidate. The Court concluded out of this that the first candidate did not in reality legally represent 75 members, but only the 15 members talked about within the papers.
The non-joinder of all of the medical schemes made the application fatally defective as the Courts couldn't find that the 1st applicant, as being a general representative of the medical schemes, would be prejudicially affected by a judgment, but discovered that its participants may all be prejudicially impacted and accordingly, all the participants should have jointly instituted the application for any declaratory order.
The Judge found that the first applicant was lacking locus standi for the following reasons:
1. The matter was one which may be classified as a representative matter, although not every one of the healthcare schemes had been amalgamated and it had not been launched as a representative topic due to the fact that the first applicant didn't have any authority to litigate on the part of all 75 of their members;
2. In order to institute action with respect to Section 38 of the Constitution, a litigant must demonstrate that a right enshrined inside the Bill of Rights has been encroached upon along with satisfactory interest in the relief wanted. The primary candidate didn't clearly aver any such encroachment and the Judge found out that the primary Litigant wouldn't be directly influenced by the judgment and was lacking an acceptable interest in the relief sought.
With respect to the second applicant the judge held it will not be successful in the application by itself, as not one of the other medical aid schemes or managers ended up being joined.
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