In the recent 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 a legal court with a demand to issue a declaratory order with regards to the explanation of the words "pay in full" in regulation 8(1) of the General Regulations made pursuant towards the Healthcare Schemes Act, 131 of 1998.
The candidates fought that the Judge required to decide three issues, that is: 1. The first applicant's right to commence actions for declaratory relief; 2. The interest and locus standi of the intervening respondents in opposing the relief searched for by way of the appliers; and 3. The meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations which were promulgated in terms of area 67 of the Act.
Regulation 8 has been around in force since 1 January 2000. According to the candidates, the current problem started on 11 November 2008 when the Appeal Board resolved two cases on appeal which was referred 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, considered the phrase "pay in full" in regulation 8 to indicate that the healthcare scheme need to make 100 % payment of the service providers' bill in respect of the costs of offering medical care services for Prescribed Minimum Benefits if you don't take the guidelines of the health care scheme into consideration in working with any claims.
It was the applicants' contention that "pay in full" suggests repayment according to the guidelines of the Healthcare Scheme, while in accordance with the respondents, the judgements by the Appeal Board haven't been challenged up to now and presently healthcare aid schemes are bound to this authority and have to repay service providers' bills fully.
The principle problem from the respondents could be that the first applicant had no immediate and substantial concern in the application since the judgment will not have an impact on it. Even though the first candidate suggested it defended 75 registered medical aid schemes and therefore had locus standi, the judge discovered this to not be. This is due to the fact that the first candidate saw fit to have the second candidate, who is an authorized professional medical aid scheme, coupled. In addition, only 15 registered medical schemes, within the founding and supplementary founding affidavits, confirmed that a declaratory order should be sought.
A Legal Court held that had the primary candidate been so certain that it defended all 75 healthcare aid schemes it wouldn't have been essential to join the other applicant or to acquire affidavits and signatures of 15 members of the 1st candidate. The Court deducted from this that the first applicant didn't in reality legally represent 75 members, but only the 15 members stated in the papers.
The non-joinder of all the medical schemes rendered the application fatally flawed as the Court could not discover that the first candidate, as a general representative of the professional medical schemes, can be prejudicially impacted by a verdict, but learned that its members may all be prejudicially influenced and consequently, all the members ought to have jointly implemented the application for a declaratory order.
A Legal Court found that the first applicant was without locus standi for the reasons:
1. The matter was one which might be classified as a representative issue, although not every one of the healthcare schemes had been joined and it has not been announced as a representative matter because of the fact that the first applicant was lacking any authority to litigate on the part of all 75 of their associates;
2. In order to start action with respect to Section 38 in the Constitution, a litigant must demonstrate that a right enshrined inside the Bill of Rights may be encroached upon along with sufficient interest in the relief sought. The primary applicant didn't clearly aver any such encroachment and the Judge found out that the primary Litigant may not be directly influenced by the judgment and was lacking an adequate interest in the relief sought.
With respect to the second candidate the judge held it will not be successful in the application on its own, as none of the alternative healthcare aid schemes or administrators have been coupled.
The candidates fought that the Judge required to decide three issues, that is: 1. The first applicant's right to commence actions for declaratory relief; 2. The interest and locus standi of the intervening respondents in opposing the relief searched for by way of the appliers; and 3. The meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations which were promulgated in terms of area 67 of the Act.
Regulation 8 has been around in force since 1 January 2000. According to the candidates, the current problem started on 11 November 2008 when the Appeal Board resolved two cases on appeal which was referred 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, considered the phrase "pay in full" in regulation 8 to indicate that the healthcare scheme need to make 100 % payment of the service providers' bill in respect of the costs of offering medical care services for Prescribed Minimum Benefits if you don't take the guidelines of the health care scheme into consideration in working with any claims.
It was the applicants' contention that "pay in full" suggests repayment according to the guidelines of the Healthcare Scheme, while in accordance with the respondents, the judgements by the Appeal Board haven't been challenged up to now and presently healthcare aid schemes are bound to this authority and have to repay service providers' bills fully.
The principle problem from the respondents could be that the first applicant had no immediate and substantial concern in the application since the judgment will not have an impact on it. Even though the first candidate suggested it defended 75 registered medical aid schemes and therefore had locus standi, the judge discovered this to not be. This is due to the fact that the first candidate saw fit to have the second candidate, who is an authorized professional medical aid scheme, coupled. In addition, only 15 registered medical schemes, within the founding and supplementary founding affidavits, confirmed that a declaratory order should be sought.
A Legal Court held that had the primary candidate been so certain that it defended all 75 healthcare aid schemes it wouldn't have been essential to join the other applicant or to acquire affidavits and signatures of 15 members of the 1st candidate. The Court deducted from this that the first applicant didn't in reality legally represent 75 members, but only the 15 members stated in the papers.
The non-joinder of all the medical schemes rendered the application fatally flawed as the Court could not discover that the first candidate, as a general representative of the professional medical schemes, can be prejudicially impacted by a verdict, but learned that its members may all be prejudicially influenced and consequently, all the members ought to have jointly implemented the application for a declaratory order.
A Legal Court found that the first applicant was without locus standi for the reasons:
1. The matter was one which might be classified as a representative issue, although not every one of the healthcare schemes had been joined and it has not been announced as a representative matter because of the fact that the first applicant was lacking any authority to litigate on the part of all 75 of their associates;
2. In order to start action with respect to Section 38 in the Constitution, a litigant must demonstrate that a right enshrined inside the Bill of Rights may be encroached upon along with sufficient interest in the relief sought. The primary applicant didn't clearly aver any such encroachment and the Judge found out that the primary Litigant may not be directly influenced by the judgment and was lacking an adequate interest in the relief sought.
With respect to the second candidate the judge held it will not be successful in the application on its own, as none of the alternative healthcare aid schemes or administrators have been coupled.
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