In a scathing rebuke, the Constitutional Court recently ruled against Profmed Medical Scheme, a health plan launched by the Professional Provident Society (PPS) and designed exclusively for professionals. Though PPS relinquished direct control of Profmed in 2002 due to regulatory conflicts, it remains affiliated through its subsidiary, PPS Healthcare Administrators, which currently oversees Profmed’s operations. The unanimous judgment by Justice Majiedt highlighted troubling gaps in Profmed’s practices, raising questions about whether the scheme’s promise of “integrity” is truly upheld.
An Eight-Year Legal Battle
The case centred around Mignon Adelia Steyn, a former Profmed member whose membership was terminated due to alleged non-disclosure of pre-existing medical conditions. Despite multiple lower courts siding with Profmed, the Constitutional Court found that the scheme had failed to act with procedural fairness. Steyn’s situation underscores the broader consequences of a scheme wielding unchecked power, impacting individuals’ access to healthcare—an especially troubling outcome for a medical scheme that claims to “put members first.”
Profmed’s Questionable Practices Exposed
Profmed argued that Steyn failed to disclose important medical details, claiming this “material non-disclosure” justified her termination. However, Profmed’s approach raised red flags; the scheme introduced new grounds for termination during the appeals process, depriving Steyn of a fair chance to respond. This procedural misstep didn’t just affect one member—it highlighted a lack of procedural fairness in Profmed’s governance, casting a shadow over its entire approach to membership disputes.
A Pitiful Attempt at Damage Control
Following the verdict, Profmed issued a statement, saying: “We understand that recent news about the Constitutional Court’s judgement in the Steyn case may raise concerns, and we want to…reassure that Profmed continues to maintain the highest level of integrity and care for all our members.” But for many, the statement rings hollow. Profmed’s claim of “integrity” hardly aligns with an eight-year legal fight over a terminated membership, a battle that arguably put profits over member care.
A Financial Focus at Members’ Expense
In its defence, Profmed cited the financial strain Steyn’s claims placed on their reserves. “The total claims in the first 11 months of membership amounted to approximately R400,000,” Profmed noted, implying that Steyn’s costs outweighed her contributions. This statement, however, starkly contrasts with the principle of medical aid—mutual support in times of need. Profmed’s focus on protecting its reserves seemingly overshadowed its duty to protect member health, leaving critics questioning its priorities.
Failing to Define “Material Non-Disclosure”
Profmed lamented that the court’s decision failed to “clarify the key concepts of material non-disclosure,” insisting that medical schemes need clear definitions for such terms in their rules. This complaint seems to deflect responsibility, shifting blame to regulatory ambiguities rather than addressing Profmed’s own lack of transparency. The court’s ruling serves as a stark reminder that Profmed, like all schemes, has an obligation to communicate clearly and fairly with its members, particularly in matters impacting health access.
Is Profmed’s “Integrity” Just a Hollow Promise?
Profmed’s statement emphasised its commitment to “protecting the reserves that you and others have built over many years.” But as the Constitutional Court ruling reveals, that “protection” seems to come at members’ expense. By prioritising financial stability over procedural fairness, Profmed risks eroding the trust it claims to value. For a medical aid scheme exclusive to professionals, this approach not only contradicts its core mission but also raises serious questions about whether it truly serves its members’ best interests.
A Win for Healthcare Transparency
The Constitutional Court’s ruling is more than just a decision against Profmed; it’s a victory for transparency and fairness in healthcare. The judgment reinforces that medical schemes are not above scrutiny and must act with procedural fairness, especially when decisions impact a member’s access to healthcare. For South African professionals seeking reliable medical aid, the verdict underscores the need for accountability in schemes that promise to prioritise their health.
Profmed’s Way Forward
In the wake of this verdict, Profmed must reflect on its values and reconsider its approach. Upholding integrity should mean more than safeguarding financial reserves—it should prioritise fairness, transparency, and genuine care for members. If Profmed truly wants to stand by its commitment to the well-being of South African professionals, this ruling offers an opportunity to recalibrate and rebuild trust with its members. Anything less would fall short of the standards professionals expect from a PPS-affiliated scheme.
ARE SOUTH AFRICAN MEDICAL SCHEMES FAILING IN THEIR DUTY TO PROTECT ALL MEMBERS?
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