In the recent 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 the judge along with a request to issue a declaratory order with regards to the meaning 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 fought that the Courts needed to decide three concerns, namely: 1. The first applicant's right to institute proceedings for declaratory aid; 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 terminology "pay in full" in regulation 8(1) of the General Regulations which were promulgated with respect to area 67 of the Act.
Regulation 8 has been in power since 1 January 2000. As reported by the appliers, the actual problem began on 11 November 2008 when the Appeal Board determined two cases on appeal which was forwarded by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to these two decisions, interpreted the phrase "pay in full" in regulation 8 to indicate that the healthcare scheme need to effect full payment of a service providers' bill in respect of the charges of delivering health care services for Prescribed Minimum Benefits without taking the principles of the professional medical scheme into account in working with any problems.
It was the applicants' argument that "pay in full" suggests payment according to the rules of the Healthcare Scheme, while according to the participants, the decisions by the Appeal Board haven't been questioned up to now and presently medical aid schemes are bound to this power and have to pay service providers' bills in full.
The primary grievance via the respondents was that the first applicant had no immediate and substantial concern in the application as the verdict would not have an effect on it. Although the first candidate contended that it defended 75 licensed medical aid schemes and for that reason had locus standi, the Court found this to not be the case. This is considering that the first candidate saw fit to have the second applicant, who is an authorized medical aid scheme, combined. In addition, only 15 registered medical schemes, within the starting and extra founding affidavits, verified that a declaratory order must be found.
A Legal Court held that had the initial applicant been so confident that it represented all 75 professional medical aid schemes it wouldn't have been essential to join the other applicant or to receive affidavits and signatures of 15 members of the 1st applicant. The Judge came to the conclusion out of this that the first applicant did not in fact represent 75 members, but only the 15 members pointed out inside the documents.
The non-joinder of all of the professional medical schemes made the application fatally flawed as the Courts could not discover that the 1st candidate, as a standard representative of the healthcare schemes, would be prejudicially impacted by a verdict, but found that its participants may all be prejudicially affected and accordingly, all the associates ought to have jointly instituted the application for a declaratory order.
A Legal Court found that the primary applicant was without locus standi for the reasons:
1. The matter was one that might be considered a representative issue, although not every one of the medical schemes have been combined and it has not been started as a representative topic because of the fact that the first applicant did not have any authority to litigate on behalf of all 75 of its members;
2. In order to commence action with respect to Section 38 of the Constitution, a litigant needs to show that the right enshrined in the Bill of Rights may be encroached upon as well as ample interest in the relief wanted. The first candidate did not expressly aver any such violation and the Court found that the First Plaintiff would not be directly affected by the judgment and did not have a satisfactory involvement with the relief sought.
Regarding the other candidate the court held it could not be successful in the application on its own, as not one of the alternative healthcare aid schemes or administrators had been amalgamated.
The candidates fought that the Courts needed to decide three concerns, namely: 1. The first applicant's right to institute proceedings for declaratory aid; 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 terminology "pay in full" in regulation 8(1) of the General Regulations which were promulgated with respect to area 67 of the Act.
Regulation 8 has been in power since 1 January 2000. As reported by the appliers, the actual problem began on 11 November 2008 when the Appeal Board determined two cases on appeal which was forwarded by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to these two decisions, interpreted the phrase "pay in full" in regulation 8 to indicate that the healthcare scheme need to effect full payment of a service providers' bill in respect of the charges of delivering health care services for Prescribed Minimum Benefits without taking the principles of the professional medical scheme into account in working with any problems.
It was the applicants' argument that "pay in full" suggests payment according to the rules of the Healthcare Scheme, while according to the participants, the decisions by the Appeal Board haven't been questioned up to now and presently medical aid schemes are bound to this power and have to pay service providers' bills in full.
The primary grievance via the respondents was that the first applicant had no immediate and substantial concern in the application as the verdict would not have an effect on it. Although the first candidate contended that it defended 75 licensed medical aid schemes and for that reason had locus standi, the Court found this to not be the case. This is considering that the first candidate saw fit to have the second applicant, who is an authorized medical aid scheme, combined. In addition, only 15 registered medical schemes, within the starting and extra founding affidavits, verified that a declaratory order must be found.
A Legal Court held that had the initial applicant been so confident that it represented all 75 professional medical aid schemes it wouldn't have been essential to join the other applicant or to receive affidavits and signatures of 15 members of the 1st applicant. The Judge came to the conclusion out of this that the first applicant did not in fact represent 75 members, but only the 15 members pointed out inside the documents.
The non-joinder of all of the professional medical schemes made the application fatally flawed as the Courts could not discover that the 1st candidate, as a standard representative of the healthcare schemes, would be prejudicially impacted by a verdict, but found that its participants may all be prejudicially affected and accordingly, all the associates ought to have jointly instituted the application for a declaratory order.
A Legal Court found that the primary applicant was without locus standi for the reasons:
1. The matter was one that might be considered a representative issue, although not every one of the medical schemes have been combined and it has not been started as a representative topic because of the fact that the first applicant did not have any authority to litigate on behalf of all 75 of its members;
2. In order to commence action with respect to Section 38 of the Constitution, a litigant needs to show that the right enshrined in the Bill of Rights may be encroached upon as well as ample interest in the relief wanted. The first candidate did not expressly aver any such violation and the Court found that the First Plaintiff would not be directly affected by the judgment and did not have a satisfactory involvement with the relief sought.
Regarding the other candidate the court held it could not be successful in the application on its own, as not one of the alternative healthcare aid schemes or administrators had been amalgamated.
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