Medical Schemes Act, 1998 (Act No. 131 of 1998)RegulationsRegulations in terms of the Medical Schemes ActChapter 5 : Provision of managed health care15G. Limitation on disease coverage |
If managed health care entails limiting coverage of specific diseases –
| a) | such limitations or a restricted list of diseases must be developed on the basis of evidence-based medicine, taking into account considerations of cost-effectiveness and affordability; and |
| b) | the medical scheme and the managed health care organisation must provide such limitation or restricted list to health care providers, beneficiaries and members of the public, upon request. |