SAfm, Tuesday afternoon

Landmark ruling by the Council for Medical Schemes Appeals Committee. They've overturned its own registrar's decision and ordered that Key Health Medical Scheme to fund life-saving treatment in full for a 15-year-old boy suffering from a rare and potentially life-threatening blood disorder. The ruling delivered at the end of October raises important questions about the rights of medical scheme members, access to expensive medicine, and whether medical schemes can restrict prescribed minimum benefits based on the option that.

Members belong to. Mark Heyman is the founder and CEO of Medi Check. He argued the appeal alongside Craig Snowman. It's great chatting to you, Mark. Thank you very much for joining us. Thank you very much for having me on the air and good afternoon to your visitors. Let's see you all at the end of the day. Let's start at the beginning. Medical terms, but just explain if you can, in layman's terms, what was wrong and why the medical aide didn't want to pay. Sorry, just hold off.

Your SAFM producers calling. Hello? All right. We got three people calling. Focus on me. Focus on me. All right. Okay. Sorry about that. Can you just explain what the issue was? We don't have to go into the full details of the disease, but why weren't the Medical Aid paying? Okay, so Medical Aid made an. Initially, they said that they weren't paying at all. I got involved in the case in June.

Medical aide came back with a counter-offer saying they would pay 50% of the cost of medicine and they required the member to upgrade his plan. We rejected that offer, saying that it was irregular in terms of the Medical Schemes Act after taking opinions from the Council for Medical Schemes prior to taking on the case. And they dug their heels in and they said, our position stands. We then went to the Victoria High.

Court and we got a ruling from the Victoria High Court that we had to wait for the Council for Medical Schemes Appeal Committee to give a ruling. And they gave a ruling last Friday in our favour, which is a landmark ruling. It's not precedent setting, but it's landmark for this child in this particular case. So is he going to get 100% of his medicine paid for now? That is the ruling from the Appeals Committee.

Of the Council for Medical Schemes. And that appeal, in terms of that, has not been placed yet by Key Health. Okay, so what does that mean for me now? Does that mean that if I have a cheap medical aid, everything needs to be paid? Yes, absolutely. That's the law. The law is very clear. No matter what plan you're on, you can be on a simple hospital plan. But the law is exceptionally clear. I'm not going to go into the act and quote you numbers, but the law is clear that anybody