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During the current 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 with a application to release a declaratory order regarding the interpretation of the phrase "pay in full" in regulation 8(1) of the General Regulations made pursuant for the Professional medical Schemes Act, 131 of 1998.
The candidates contended that the Court needed to determine three concerns, that is: 1. The first applicant's entitlement to institute actions for declaratory relief; 2. The interest and locus standi of the intervening members in opposing the relief sought by the applicants; and 3. The meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations which were promulgated in terms of section 67 of the Act.
Regulation 8 has been around in power since 1 January 2000. As reported by the appliers, the actual problem started on 11 November 2008 once the Appeal Board resolved two cases on appeal which were referred from the Appeal Committee in terms of 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 healthcare scheme should make full repayment of the service providers' invoice in respect of the costs of providing medical care services for Prescribed Minimum Benefits without taking the principles of the professional medical scheme into consideration in working with any grievances.
It was actually the applicants' argument that "pay in full" signifies repayment according to the rules of the Healthcare Scheme, while in accordance with the respondents, the decisions by the Appeal Board haven't been challenged up to now and presently professional medical aid schemes are bound to this power and have to repay service providers' invoices entirely.
The primary gripe from the participants could be that the first applicant had no immediate and significant concern in the application since the judgment would not have a direct effect over it. Even though the first candidate suggested it defended 75 licensed medical aid schemes and for that reason had locus standi, the Court found this not to be. This is because of the reason that the first candidate saw fit to have the second candidate, who is an authorized professional medical aid scheme, combined. Moreover, only 15 licensed medical schemes, in the starting and supplementary founding affidavits, verified that the declaratory order ought to be found.
A Legal Court held that had the initial candidate been so certain that it represented all 75 medical aid schemes it wouldn't have been essential to join the 2nd applicant or to get hold of affidavits and signatures of 15 members of the first applicant. A Legal Court deducted out of this that the first candidate didn't in reality legally represent 75 members, but only the 15 members mentioned within the documents.
The non-joinder of all the professional medical schemes made the application fatally flawed as the Judge couldn't discover that the first candidate, as a standard representative of the professional medical schemes, can be prejudicially impacted by a ruling, but discovered that its participants may all be prejudicially affected and consequently, all the participants should have jointly instituted the application for a declaratory order.
The Judge found that the 1st applicant was without locus standi for the reasons:
1. The matter was one which could be classified as a representative issue, although not all the healthcare schemes have been amalgamated and it has not been started as a representative issue due to the fact that the first applicant was lacking any authority to litigate on behalf of all 75 of their associates;
2. In order to initiate steps with respect to Section 38 in the Constitution, a litigant needs to show that the right enshrined in the Bill of Rights has been encroached upon along with enough concern in the relief desired. The 1st applicant didn't clearly aver any such violation and the Court found out that the First Litigant wouldn't be directly affected by the ruling and did not have an adequate interest in the relief sought.
With regard to the other candidate the judge held it will not be successful in the application by itself, as not one of the other healthcare aid schemes or administrators have been amalgamated.
The candidates contended that the Court needed to determine three concerns, that is: 1. The first applicant's entitlement to institute actions for declaratory relief; 2. The interest and locus standi of the intervening members in opposing the relief sought by the applicants; and 3. The meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations which were promulgated in terms of section 67 of the Act.
Regulation 8 has been around in power since 1 January 2000. As reported by the appliers, the actual problem started on 11 November 2008 once the Appeal Board resolved two cases on appeal which were referred from the Appeal Committee in terms of 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 healthcare scheme should make full repayment of the service providers' invoice in respect of the costs of providing medical care services for Prescribed Minimum Benefits without taking the principles of the professional medical scheme into consideration in working with any grievances.
It was actually the applicants' argument that "pay in full" signifies repayment according to the rules of the Healthcare Scheme, while in accordance with the respondents, the decisions by the Appeal Board haven't been challenged up to now and presently professional medical aid schemes are bound to this power and have to repay service providers' invoices entirely.
The primary gripe from the participants could be that the first applicant had no immediate and significant concern in the application since the judgment would not have a direct effect over it. Even though the first candidate suggested it defended 75 licensed medical aid schemes and for that reason had locus standi, the Court found this not to be. This is because of the reason that the first candidate saw fit to have the second candidate, who is an authorized professional medical aid scheme, combined. Moreover, only 15 licensed medical schemes, in the starting and supplementary founding affidavits, verified that the declaratory order ought to be found.
A Legal Court held that had the initial candidate been so certain that it represented all 75 medical aid schemes it wouldn't have been essential to join the 2nd applicant or to get hold of affidavits and signatures of 15 members of the first applicant. A Legal Court deducted out of this that the first candidate didn't in reality legally represent 75 members, but only the 15 members mentioned within the documents.
The non-joinder of all the professional medical schemes made the application fatally flawed as the Judge couldn't discover that the first candidate, as a standard representative of the professional medical schemes, can be prejudicially impacted by a ruling, but discovered that its participants may all be prejudicially affected and consequently, all the participants should have jointly instituted the application for a declaratory order.
The Judge found that the 1st applicant was without locus standi for the reasons:
1. The matter was one which could be classified as a representative issue, although not all the healthcare schemes have been amalgamated and it has not been started as a representative issue due to the fact that the first applicant was lacking any authority to litigate on behalf of all 75 of their associates;
2. In order to initiate steps with respect to Section 38 in the Constitution, a litigant needs to show that the right enshrined in the Bill of Rights has been encroached upon along with enough concern in the relief desired. The 1st applicant didn't clearly aver any such violation and the Court found out that the First Litigant wouldn't be directly affected by the ruling and did not have an adequate interest in the relief sought.
With regard to the other candidate the judge held it will not be successful in the application by itself, as not one of the other healthcare aid schemes or administrators have been amalgamated.
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