READ OUR ARTICLE RELATING TO THE MOST SHOCKING AND DISGRACEFUL CONDUCT ON THE PART OF DISCOVERY HEALTH, THEIR ATTORNEY AND PROXY ATTORNEYS: A SHOCKING DISCOVERY FOR DISCOVERY MEDICAL AID MEMBERS THE REAL REASON FOR DISCOVERY’S VENDETTA AGAINST RONALD BOBROFF and RONALD BOBROFF & PARTNERS INC. EXPOSED DISCOVERY’S WILFUL NON-DISCLOSURE OF HIDDEN RULES AND EXCLUSIONS, AND NON-COMPLIANCE WITH THE MEDICAL SCHEMES ACT NO. 131 OF 1998 1. Are you a member of Discovery Medical Aid and if so, did its Broker or anyone else on its behalf ever tell you, that the only medical care you and your dependents are unconditionally entitled to as of right is that arising out of illness. Were you told that medical care due to the act of another –e.g. Road Accidents, workplace Injuries, dog bites, assaults and so on are excluded unless you agree in writing, under threat of immediate termination of medical care and a further threat that you have to refund the cost of care already provided to your or your dependants, to claim from the wrongdoer at your own risk and cost and to thereafter reimburse Discovery in full any medical costs paid by it. 2. Did you ever receive a “detailed summary” of Discovery’s rule when you became a member? Despite the Medical Schemes Act making this compulsory in terms of Section 30(2) (a) - RBP and many members of the South African Association of Personal Injury Lawyers (“SAAPIL”), are yet to find a single member client of Discovery Medical Aid, who ever received this or ever had the benefit of Discovery complying with numerous compulsory provisions of the Medical Schemes Act. A schedule of some of these provisions is attached. *(Annexure_1 Summary of the Provisions of the Medical Schemes Act/Click here) 3. 3.1 If you had received this detailed summary you would have been shocked to find out something which Discovery Medical Scheme, and its Administrator, Discovery Medical Aid Administrators Limited, have very successfully managed to conceal from prospective members and actual members of the Scheme for decades. 3.2 Tucked away in Discovery’s never disclosed rules, is Rule 15.6.1 and Annexure “C”) which contains exclusions entitling Discovery to refuse you or your dependents any medical care which is due, “to the act of another” unless you agree, at your own risk and cost, to claim on Discovery’s behalf against the alleged wrongdoer for repayment of all medical costs paid by Discovery for your treatment. In practice this means that you have to bear the cost of your own Attorney, Advocates and medical experts, as also to face the risk of having to pay the Defendant’s/Road Accident Fund’s (RAF) legal costs – which in an ordinary High Court trial usually exceeds hundreds of thousands of Rands - should your claim prove unsuccessful. *(Annexure_2 Rule 15.6.1 of Discoverys letters forcing members to sign/click here) 4. 4.1 The first time most members of the Scheme find out about these hidden rules, is when they or a dependent are injured in a road accident, often in intensive care fighting for life. They or their families are then confronted by an employee from Discovery’s in house Road Accident Fund Medical Costs recovery department, headed up by Jeffrey Katz. A demand is made that the member or the dependent sign/s Discovery’s unlawful undertaking*, in which they/the victim agrees to make a claim against the Road Accident Fund (“RAF”) at own risk and cost, and to refund Discovery in full. *(Annexure_3 Undertaking to Discovery Health/click here) 4.2 The undertaking document repeats the threat made by Discovery’s staff to the member or the dependent, that the Scheme will immediately terminate all medical care and claim back the cost of care already rendered should the member refuse to sign the document. This means that the member (you) or the dependent either has to come up with hundreds of thousands of Rands to deposit with the hospital, or lacking the resources to do so, transfer the loved one to a State Hospital; or sign Discovery’s unlawful undertaking. So, in reality there is no choice at all given the current state of affairs in public health facilities. 4.3 By acting this way Discovery also contravenes Regulation 10 of the Medical Schemes Act which prohibits any Medical Aid from refusing to provide Prescribed Minimum Benefit care to any member – P.M.B.’s specifically includes emergency care which is invariably required to save the lives of seriously injured road accident victims. *(Annexure_4 Regulation 10 of the Medical Schemes Act regarding brokers/click here) 4.4 G.E.M.S – Government Employee’s Medical Scheme - the second largest Medical Aid in South Africa, under signature of its then CEO Dr Eugene Watson, issued a press release in April 2012 stating that it had removed from its rules any requirement that members injured in road accidents should be obliged to claim medical expenses from the RAF and reimburse the Scheme. 4.5 Dr Watson who has now moved on to become CEO of the Road Accident Fund, said that the scheme was doing so because it regarded such rules as unfair; especially since members were paying insurance premiums to the Scheme, in the justifiable expectation that they would receive medical care irrespective of the cause giving rise to the need for such care. *(Annexure_5 Press release from GEMS removing the rule to reimburse the scheme for past medical expenses/click here) 4.6 Discovery has not to date adopted a similar ethical approach, but continues to harass and bully members or their dependents who require medical care arising out of road accidents, as is described in the statements and affidavits by RBP clients/Discovery members in paragraphs 8.4 and 8.5. *see below for details as to where to lodge complaints against Medical Aids. 1. The Council for Medical Schemes - complaints@medicalschemes; 2. National Consumer Protection Commissioner - [email protected]; 3. The Public Protector, Thuli Madonsela - [email protected]. Read more: A SHOCKING DISCOVERY FOR DISCOVERY MEDICAL AID MEMBERS ANNEXURES - A SHOCKING DISCOVERY FOR DISCOVERY MEDICAL AID MEMBERS SCHEDULE OF ANNEXURES TO RBP INC – A SHOCKING DISCOVERY FOR DISCOVERY MEDICAL AID MEMBERS ITEM DETAILS PAGE NO: 1 Annexure 1 - Summary of the Provisions of the Medical Schemes Act 34-37 2 Annexure 2 – Rule 15.6.1 of Discovery’s letters forcing members to sign 38-39 3 Annexure 3 – Undertaking to Discovery Health 40-41 4 Annexure 4 – Regulation 10 of the Medical Schemes Act regarding brokers 42 5 Annexure 5 – Press release from GEMS removing the rule to reimburse the 43 6 Annexure 6 – Undertaking in favour of Discovery which Mark Bellon was forced to sign 44 7 Annexure 7 – Threatening letter by Jeffrey Katz to Law Society and disclosing major 45-46 8 Annexure 8 – Affidavits by Discovery members Mark Bello, Dean Almeida, Ms. Vawda 47-61 9 Annexure 9 – Statements of complaint against Katz by Mark Bello and Dean Almeida 62-73 10 Annexure 10 – Letters by Houghton Harper to Discovery regarding Katz’s threats 74-77 11 Annexure 11 – Extract of paper by Judge Malcolm Wallis 78 12 Annexure 12 – Law Society’s ruling on the validity of common law contingency 79-86 13 Annexure 13 – Common law fee agreement between Ms. De la Guerre and 87-89 14 Annexure 14 – Statements of account by Joseph’s Inc. 90-101 15 Annexure 15 – Affidavits of touted clients and Millar’s tout Mr. Jabu Gxokwa 102-106 16 Annexure 16 – Affidavits of Hennie Scholtz and Jacque de Klerk 107-111 17 Annexure 17 – Photos of Discovery’s Katz with De La Guerre and Berger and Millar 112-114 18 Annexure 18 – Letter sent by Berger and Millar attempting to tout / solicit 115-116a 19 Annexure 19 – Common Law Contingency Fee Agreements of other 116b-119 20 Annexure 20 - Business Day article 120-122 21 Annexure 21 – Report by James Styan in FinWeek 123-125 22 Annexure 22 – Affidavit by Martha Kock 126-129 23 Annexure 23 – Certificate of 40 year unblemished record issued to 130 24 Annexure 23A - Discovery letter to RBP Clients 131 -------------------------------------------------------------------------------- Ronald Bobroff and Partners response to Discovery Health statement 27.10.2014 1. Cover for motor vehicle accidents in claims against the Road Accident Fund Discovery alleges; It does not differentiate between medical claims resulting from motor vehicle accidents and claims resulting from illness and that it always pays … no questions asked - it however fails to explain why it has a special rule 15.6.1 which specifically imposes special obligations on a member who sustains an injury “as a result of or arising out of the negligent driving of a motor vehicle …. The member or dependant shall be obliged to take all steps which are necessary to timeously submit to the RAF … a claim for compensation for the costs of any Health care services performed and which in the future may be necessitated in connection with such injury”. View the rule as annexure 2 to RBP’s main document. It does not differentiate between medical claims resulting from any other accident or illness. Discovery dishonestly is silent as to annexure C to its never disclosed rules headed Exclusions and limitations. Section 2 of Annexure C to be viewed as annexure 2 to RBP’s main document states “expenses incurred in connection with clause 15.12 of the main body as well as any of the following, will not be paid by the scheme: all costs of whatsoever nature incurred for treatment of sickness conditions or injuries sustained by a member or a dependant and for which any other party is liable”. In plain English medical care required from dog bites, slip and fall, assaults, shootings, missing man hole covers, train accidents, and any other occurrence you would like to think of is excluded!. The scheme does not force members to claim from the RAF. Discovery understandably fails to explain why it then compels members or their dependants who sustain injury in road accidents to sign its illegal and immoral undertaking document which specifically states in paragraph 4 thereof “I have been informed that should I not undertake to reimburse Discovery Health or if I fail to honour my obligation in terms of this Undertaking for past hospital and medical expenses paid on my behalf for injuries sustained by me in the incident, any payments made by Discovery Health will be reversed and will be for my account. Furthermore, Discovery Health will disavow liability for payment of any future costs relating to the incident”. As if that were not bad enough Discovery makes it clear that the member is compelled to bear the legal costs involved, as also by implication any adverse costs order if the claim should be unsuccessful where the undertaking document states “I confirm that no legal fees or disbursements will be deducted from the amount in respect of the costs payable to Discovery Health”. View Discovery’s undertaking document as annexure 3 to RBP’s main document. If a member or dependant receives compensation from the RAF for medical expenses, the member must then refund those amounts previously paid by the Scheme for the members medical expenses. This is to avoid the member being unjustly enriched at the expense of the Scheme by receiving double compensation for the same health event. Members pay an insurance premium in return for which they reasonably expect that they will receive medical care from the scheme arising out of any instance. As referred to on page 2 of RBP’s main document the second largest medical scheme in South Africa – G.E.M.S issued a press release in 2012 stating that it had removed from its rules any requirement that members injured in road accidents should be obliged to claim medical expenses from the RAF and reimburse the scheme. It stated that such rules were unfair since members were paying insurance premiums to the scheme and the justifiable expectation that they would receive medical care irrespective of the casue giving rise to the need for such care. Discovery constantly refers to the principal of subrogation i.e. where an insurer compensates an insured, the insured in return for such compensation agrees at absolutely no risk and cost to assist the insurer in recovering whatever the insurer has paid out from the wrongdoer. The insurer specifically indemnifies the insured against any adverse cost order which might be made against the insured if the claim instituted by the insurer in the name of the insured is dismissed by the court. Discovery of course, as is noted in its rule 15.6, its exclusion annexure and its undertaking document specifically requires the member to bear all the legal costs involved and offers no indemnity to the member against the adverse costs order in the event of an unsuccessful claim. Adv Kemp, J Kemp, SC after considering Discoverys rules and conduct, furnished a written opinion to the effect that Discovery was not entitled to receive any reimbursement whatsoever, save that in respect of future medical expenses arising after the accident the injured person would be limited to claiming either from the medical scheme or the RAF but not both. 2. Over reaching and Over charging against Mr Bobroff The one and only matter before a Law Society Disciplinary Committee, against RBP is the contrived Graham Complaint. The Law Society itself recognised that the application launched against Ronald Bobroff / RBP and the Law Society in the Grahams’ name was “essentially not sought by the Grahams but by Van Niekerk and /or Discovery, on whose behalf Van Niekerk acts. It is abundantly clear that the applicants (the Graham’s) play a secondary role in these proceedings”. See page 14 of RBP’s main document and view the Law Society’s full affidavit as referred to on page 14 on RBP’s website. Further the Law Society stated in its affidavit “that Van Niekerk (of ENS Cape Town) ... is acting in interests other than those of the applicants (the Grahams i.e. Discovery), which Van Niekerk admits instructs him and pays his bills”. Law Society Affidavit 4.4.2013, paragraph 5.18 may be viewed on RBP’s website under Law Society Affidavits. “despite the obvious involvement of Discovery, Van Niekerk attempts to explain that the applicants (the Grahams)… bring the application in the interests of the public. I do not accept this contention, especially in view of the fact that the applicant’s legal costs in the application are paid by Discovery. It is furthermore apparent that this application is the result of a personal and highly acrimonious dispute between Discovery, assisted by Van Niekerk and the third respondent (Ronald Bobroff)”. Law society affidavit 04.04.2013 paragraph 10. RBP and the Law Society have been striving to afford the Grahams an opportunity of appearing as complainants before the Law Society’s disciplinary committee and stating in their own words exactly what their complaints are. Van Niekerk is understandably most concerned that the contrived complaints will be exposed as smoke and mirrors and that the truth will out within minutes of cross-examination by Hellens, SC. He therefore cunningly engineered repeated postponements of hearings set by the Law Society for the 28th of November 2012 and June 2013, by launching applications for postponement thereof, alleging in respect of the 2012 hearing that he was in Atlanta, notwithstanding that the date had been arranged between himself and the Law society in September of 2012. The Law Society makes reference to this in its affidavits which may be viewed on RBP’s website under the heading Law Society Affidavits. The law society has described Van Niekerk’s conduct in affidavits filed by it as “appalling”. RBP is anxious that the Graham complaint be heard as soon as possible and is confident that all the allegations will be found to be untrue, concocted and without merit. 3. Reference to court orders against RBP and Partners RBP in common with the 18 000 attorneys regulated by the Law Society of the Northern Provinces and the Free state Law Society, have in accordance with rulings permitting attorneys to enter into common law contingency fee contracts with clients, also done so. Extensive reference is made to the background of the Law Society’s good faith decision to do so, the law applicable prior to 2013 and which permitted such agreements, and of course the fact that Discovery’s own panel attorneys chosen and supervised by Jeffery Katz of its legal department, utilised precisely the same common law fee agreements as RBP did. Judge Cameron in 2001 and appeal court Judge Malcolm Wallis in 2010 recognised the validity of common law contingency fee agreements. Even the constitutional Court when considering the SAAPIL appeal recognised the widespread differences of opinion and confusion in the attorneys profession about the correct legal position in relation to contingency fees when it stated “Certain Law Societies made rulings allowing their members to charge in excess of the percentages set in the Act. Uncertainty reigned in the attorneys’ profession about the correct legal position in relation to Contingency fees. Could these fees be charged only under the Act, or also outside the provisions?” The Court went on to note that “Bobroff was one of the firms which charged more than allowed for in the Act, as the rules of its professional association allowed”. It is therefore hypocritical and malicious for Discovery Health to attack Ronald Bobroff and RBP for utilising common law contingency fee agreements in the circumstances referred to above. It is certainly clear proof of discovery’s vendetta against Ronald Bobroff and RBP Inc when being aware of the truth to single out RBP clients alone- Discovery has not to the best of our knowledge written to its members who are clients of any other attorneys inciting them to sue such attorneys, as it has done to RBP’s clients. Even more so is this vendetta exposed where Discovery’s response states “Discovery Health has supported these cases against Ronald Bobroff and Partners because we believe that we have an obligation to assist and protect our members, particularly those that find themselves in a vulnerable position. 4. Unfounded claims from Mr Ronald Bobroff The scheme does not adequately inform members of the Scheme rules and, as a result, has no right to be refunded RAF claims in respect of medical costs incurred by the Scheme on behalf of the member. Despite repeated allegations by Ronald Bobroff since 2011 that Discovery has not and does not comply with cardinal peremptory provisions of the medical schemes act, in that it has not and does not inform or instruct its brokers to make full disclosure of Discovery’s own risk exclusions and conditions applicable to Road Accident medical costs, that it has not and does not furnish members on admission as members of the scheme with the detailed summary of the rules required by the act, and numerous other sections of the act as referred to in annexure 1 in RBP’s main document; Discovery has never furnished proof or indeed specifically alleged that it has and does comply with those sections of the Act. Readers who are members of discovery are invited to contact RBP on [email protected] if they have never had the benefit of discovery complying with those compulsory provisions of the Act and that they feel aggrieved. RBP will shortly place on its website the email addresses of the appropriate bodies to whom Discovery members may lodge complaints in respect of Discovery’s illegal non-compliance with the act. Reference to ruling by Council for Medical Schemes Mark and Jody Bellon, former employees of Discovery, and members thereof lodged a complaint with the registrar of the Medical Schemes Council in respect of Discovery’s non-compliance with the Act, its consequent failure to ever inform the Bellons in terms of the compulsory provisions of the Medical Schemes Act of Discovery’s oppressive conditions and exclusions applicable to road accident generated medical care. The registrar (since suspended on allegations of bribery to the tune of some R3 million) permitted Discovery a lengthy extension of time to respond to the complaint so that it could brief senior counsel Bhana, Sc to prepare its response, and without ever making Bhana’s massive tome available to RBP so that instructions could be obtained from Mark and Jody Bellon, the registrar proceeded to deliver a tailor made finding in favour of Discovery filled with unsustainable conclusions and findings, and in essence amounting to a cut and paste of Bhana’s submission. That finding is on appeal, a fact which Discovery conveniently forgets to mention when making reference to such finding. Intriguingly the registrar held that a line or two in Discoverys 2004 and 2006 benefits booklet was sufficient compliance with section 30(2)(a) of the act which requires that a detailed summary of the rules be sent to members Even more intriguing was the issuing of a media release by the registrar, parroting Discoverys tune, within a short time after Ronald Bobroff had exposed Discovery’s director Jonathan Broombergs inability to truthfully admit on John Robbies 702 show in 2012, that Discovery had not and did not comply with the various peremptory provisions of the medical schemes act, specifically furnishing members with a detailed summary of the schemes rules. Discovery health members and their families are approached while in hospital and forced to sign undertakings to refund the Scheme in respect of RAF reimbursements. Discovery states: no discovery health employee ever approached a member in hospital in this regard. Readers are referred to the affidavits by Mark and Jody Bellon referred to in paragraph 5 of RBP’s main document in which both Mark and Jody depose on oath as to how they were harassed and intimidated by Discovery. Jody whilst mark was in a coma in hospital, and Mark while he was still suffering major sequelae from his brain injury. RBP has affidavits in its possession by other Discovery members deposing as to similar harassment and intimidation. All discovery health members are guaranteed coverage in respect of the medical costs incurred as a result of a motor vehicle accident. If this is so why then does Discovery have its notorious and never disclosed Rule 15.6.1 and Annexure C of exclusions as referred to above. Why does it continue as recently as last week to compel members injured in Road Accidents to sign its illegal undertaking document under threat of termination of medical care and the reclaiming of the costs of care already rendered. Given the inability of the vast majority of South Africans, and certainly a large proportion of Discovery’s members to afford to pay for the cost of private health care following serious road accident injury, members have little choice but to sign Discovery’s undertaking document. Discovery members are encouraged to pose the following questions in writing to their brokers and or to Messrs Broomberg, Swartzberg and Gore: 1.Why did the Discovery broker fail to disclose Discovery’s Rule 15.6 and Annexure C to the Rules which effectively deprive members and or their dependants of all medical care save that occasioned by illness, unless the member at own risk and cost agrees to claim from the wrongdoer; 2.Why Discovery deliberately failed to comply with the law-Section 30(2)(a) of the Medical Schemes Act which compels a scheme to send the member a detailed summary of the rules setting out benefits and exclusions; 3.If Discovery now alleges that it never refuses medical care to road accident victims why has it for more than a decade forced members injured in road accidents to sign its illegal undertaking document, which specifically threatens in paragraph 4 thereof that no medical care will be provided and the cost of care already rendered will be reclaimed, if the member refuses to sign the undertaking to claim against the road accident fund at the members own risk and cost; 4.Where Discovery has forced members injured in road accidents to sign its illegal undertaking document and unlawfully duress the member into paying Discovery out of the proceeds of the litigation conducted at the members own risk and cost, will Discovery now refund this money with interest to the member; 5.Given the exposure of Discovery’s fraudulent non disclosure of its exclusions and conditions applicable to road accident and other non illness generated medical care and Messrs Broomberg and Streaks recent statement that Discovery never enforces this Rule 15.6 and exclusion clause depriving members of medical care arising from circumstances other than illness; will Discovery immediately publicly announce the removal of Rule 15.6 and the exclusion in Annexure C from its rules and never again force members to sign undertakings to claim from the road accident fund at the members own risk and cost as a condition for members receiving trauma related medical care; 6.Will Discovery publicly undertake to immediately send every member the detailed summary of the rules required in terms of Section 30(2)(a) of the Medical Schemes Act and to do so in respect of every member admitted to the scheme going forward; 7.Will Discovery make specific reference on its membership application form which prospective members are required to sign of the detailed content of its Rule 15.6 and exclusion Annexure, should Discovery not immediately undertake to remove Rule 15.6 and Annexure C exclusions from its Rules; 8.Will Discovery undertake to immediately cease forwarding any details of members injured in road accidents to its panel attorneys and to immediately stop requiring members to sign undertakings that the member will claim from the road accident fund as a condition of receiving road accident generated medical care; 9.Will Discovery immediately issue a public statement and forward notifications to everyone of its members that no distinction will be made between medical care required by members from illness as opposed to road accident or other trauma related injuries and that no conditions whatsoever will be imposed on members who require medical care arising from causes other than illness. EMAIL ADDRESSES: MR ADRIAN GORE: [email protected] DR JONATHAN BROOMBERG: [email protected] MR BARRY SWARTZBERG: [email protected] -------------------------------------------------------------------------------- Fin24 - Nov 12 2014 Discovery clarifies road accident clause Cape Town - After falling off his motorcycle on a dirt road and without any other parties being involved, a Fin24 user, who wants to remain anonymous, but whose details are known to Fin24, claims he received an email from Discovery informing him of his “duty” to claim from the Road Accident Fund (RAF) and then reimburse Discovery for medical expenses. I replied that this was not an option as there were no other parties involved and it was an offroad adventure riding event, writes the Fin24 user. He wrote in reaction to previous articles on Fin24 regarding Discovery and the RAF. In one of the Fin24 articles Discovery claims it no longer requires members to sign the undertaking that required them to claim from the RAF. This means that they did in fact require their members, at their own cost and risk, to claim from the RAF to reimburse Discovery. So Broboff et al are actually correct on this, writes the Fin24 user. To him Discoverys rule regarding claiming from the RAF in order not to be compensated twice for an event is ludicrous. Forcing a member to claim at the members cost and risk implies a double penalty for the same event in the event of an unsuccessful claim, says the Fin24 user. If a claim is lodged with the RAF - for example for pain and suffering and loss of income and not for medical expenses – will Discovery claim a right to this money? Who is Discovery to tell me what I can, cannot or must claim after my accident in order to reimburse them for the expenses they are obliged to pay in respect of my monthly medical aid premium? The Fin24 user feels Discovery is making their members “de-facto risk managers. A premium is paid to a medical aid as an insurance premium. The insurer then undoubtedly re-insures a component of this premium. If the member then refunds Discovery for payment of medical expenses, then it will be Discovery who in fact benefits twice from the same client, writes the Fin24 user. He refers to the 2012 annual report of Discovery Health Medical Scheme which states that it paid R3.4bn to its administrator, Discovery Health. In addition Discovery Health received R256m more from 13 smaller schemes it manages. During the period under review, Discovery Health made an operating profit of R1.5bn, or 44% of the group’s overall operating profit of R3.44bn. And now they want to be refunded more? By me? And at my cost and risk? Seriously? writes the Fin24 user. I am expecting that Discovery will say that its RAF claim policy is to keep the medical scheme affordable and reduce premiums. If they do take this line, then read it in context with the R3.4bn it pays its administrator. Dr Jonathan Broomberg, CEO of Discovery Health, responds: The RAF clause has been in the rules since 2000, based on the model rules of the Council for Medical Schemes (CMS). Notwithstanding the rules, Discovery Health Medical Scheme (DHMS) has never enforced this rule and will never force a member to submit a claim to the RAF. The board of trustees will consider a change to the rule to clarify that submission of claims to the RAF at the discretion of the member. Attorneys Bobroff et al have claimed that DHMS forces members to submit claims to the RAF and has deliberately failed to disclose this to members. This is completely false. It is a well accepted principle of South Africa’s common law that no person should benefit twice from an insured event. All medical schemes and other insurers have policies that comply with this law. Members who claim from the RAF do so at their own election, typically to secure payouts for general damages, loss of income etc. Only if and when they receive compensation for medical expenses already paid out by the medical scheme are they required to refund that amount to the scheme. The Council for Medical Schemes, the regulatory authority for medical schemes, supports this important principle. Discovery Health Medical Scheme would only ever require a member to refund what the RAF has paid out for medical expenses. The medical scheme would not be entitled to request a member to refund any payouts for other components. There is no re-insurance in the Discovery Health Medical Scheme. At best, the medical scheme would recover all or some of the medical expenses it has already paid out on behalf of the member. In aggregate, DHMS has paid out approximately R2bn in the past six years on around 25 000 accidents and has recovered approximately R330m of this in refunds from members who received RAF payouts. It is important to note that DHMS is, by law, a not for profit trust owned by its members. Any monies recovered from the RAF are, therefore, retained in the scheme and assist in keeping premiums affordable into the future. Regarding the 2012 figures quoted by the Fin24 user: Do not confuse Discovery Health, the administrator, with the Discovery Health Medical Scheme (DHMS). The DHMS is a non-profit entity managed by a board of trustees. Its sole purpose is to pay for medical expenses for its members. It is DHMS, and therefore all its members, which benefits when a RAF claim is paid back to the scheme. Discovery Health is paid a fixed fee per policy per month and does not benefit in any way from refunds to DHMS from RAF payouts.
Posted on: Wed, 10 Dec 2014 09:33:51 +0000