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 along with a application to issue a declaratory order regarding the interpretation of the phrase "pay in full" in regulation 8(1) of the General Regulations made pursuant for the Healthcare Schemes Act, 131 of 1998.
The candidates fought that the Court needed to consider three issues, namely: 1. The first applicant's entitlement to commence procedures for declaratory aid; 2. The interest and locus standi of the intervening members in opposing the relief looked for by way of the applicants; and 3. The concise explanation of the phrase "pay in full" in regulation 8(1) of the General Regulations which were promulgated with respect to section 67 of the Act.
Regulation 8 has been in power since 1 January 2000. According to the candidates, the actual problem commenced on 11 November 2008 once the Appeal Board determined two cases on appeal which were forwarded by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to those two judgements, interpreted 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 costs of supplying healthcare services for Prescribed Minimum Benefits if you don't take the principles of the medical scheme into consideration in dealing with any grievances.
It was the applicants' dispute that "pay in full" means payment according to the policies of the Healthcare Scheme, while in accordance with the participants, the decisions by the Appeal Board have not been challenged as yet and presently healthcare aid schemes are bound to this authority while having to pay for service providers' invoices completely.
The principle claim by the participants was that the first applicant had no immediate and significant concern in the application as the judgment would not have a direct effect on it. Although the first candidate contended it represented 75 licensed medical aid schemes and for that reason had locus standi, the Court identified this to not be the case. This was because of the reason that the first candidate saw fit to have the second applicant, who is a registered professional medical aid scheme, coupled. In addition, only 15 licensed medical schemes, in the founding and extra founding affidavits, verified that a declaratory order must be found.
A Legal Court held that had the 1st applicant been so sure that it represented all 75 healthcare aid schemes it wouldn't have been essential to join the second applicant or to acquire affidavits and signatures of 15 members of the 1st applicant. A Legal Court concluded out of this that the first candidate did not in reality legally represent 75 members, but only the 15 members stated in the documents.
The non-joinder of all of the healthcare schemes made the application fatally flawed as the Judge could not find that the primary candidate, as being a general representative of the professional medical schemes, can be prejudicially affected by a verdict, but found that its participants may be prejudicially impacted and accordingly, many of the members should have jointly instituted the request for the declaratory order.
The Court learned that the primary applicant was lacking locus standi for the following reasons:
1. The matter was one that may be considered a representative issue, although not all the healthcare schemes had been amalgamated and it had not been launched as a representative issue because of the fact that the first candidate was lacking any authority to litigate on behalf of all 75 of its associates;
2. In order to institute action in terms of Section 38 in the Constitution, a litigant needs to show that the right enshrined inside the Bill of Rights may be encroached upon as well as satisfactory concern in the relief wanted. The initial candidate did not clearly aver such infringement and the Court found that the 1st Plaintiff wouldn't be directly influenced by the ruling and didn't have a satisfactory interest in the relief sought.
With respect to the second applicant the court held it will not be successful in the application on its own, as not one of the alternative medical aid schemes or administrators had been joined.
The candidates fought that the Court needed to consider three issues, namely: 1. The first applicant's entitlement to commence procedures for declaratory aid; 2. The interest and locus standi of the intervening members in opposing the relief looked for by way of the applicants; and 3. The concise explanation of the phrase "pay in full" in regulation 8(1) of the General Regulations which were promulgated with respect to section 67 of the Act.
Regulation 8 has been in power since 1 January 2000. According to the candidates, the actual problem commenced on 11 November 2008 once the Appeal Board determined two cases on appeal which were forwarded by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to those two judgements, interpreted 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 costs of supplying healthcare services for Prescribed Minimum Benefits if you don't take the principles of the medical scheme into consideration in dealing with any grievances.
It was the applicants' dispute that "pay in full" means payment according to the policies of the Healthcare Scheme, while in accordance with the participants, the decisions by the Appeal Board have not been challenged as yet and presently healthcare aid schemes are bound to this authority while having to pay for service providers' invoices completely.
The principle claim by the participants was that the first applicant had no immediate and significant concern in the application as the judgment would not have a direct effect on it. Although the first candidate contended it represented 75 licensed medical aid schemes and for that reason had locus standi, the Court identified this to not be the case. This was because of the reason that the first candidate saw fit to have the second applicant, who is a registered professional medical aid scheme, coupled. In addition, only 15 licensed medical schemes, in the founding and extra founding affidavits, verified that a declaratory order must be found.
A Legal Court held that had the 1st applicant been so sure that it represented all 75 healthcare aid schemes it wouldn't have been essential to join the second applicant or to acquire affidavits and signatures of 15 members of the 1st applicant. A Legal Court concluded out of this that the first candidate did not in reality legally represent 75 members, but only the 15 members stated in the documents.
The non-joinder of all of the healthcare schemes made the application fatally flawed as the Judge could not find that the primary candidate, as being a general representative of the professional medical schemes, can be prejudicially affected by a verdict, but found that its participants may be prejudicially impacted and accordingly, many of the members should have jointly instituted the request for the declaratory order.
The Court learned that the primary applicant was lacking locus standi for the following reasons:
1. The matter was one that may be considered a representative issue, although not all the healthcare schemes had been amalgamated and it had not been launched as a representative issue because of the fact that the first candidate was lacking any authority to litigate on behalf of all 75 of its associates;
2. In order to institute action in terms of Section 38 in the Constitution, a litigant needs to show that the right enshrined inside the Bill of Rights may be encroached upon as well as satisfactory concern in the relief wanted. The initial candidate did not clearly aver such infringement and the Court found that the 1st Plaintiff wouldn't be directly influenced by the ruling and didn't have a satisfactory interest in the relief sought.
With respect to the second applicant the court held it will not be successful in the application on its own, as not one of the alternative medical aid schemes or administrators had been joined.
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