Medical Schemes Act, 1998 (Act No. 131 of 1998)

Regulations

Purchase

If managed health care entails the use of a protocol –

a)	such protocol must be developed on the basis of evidence-based medicine, taking into account considerations of cost-effectiveness and affordability;

b)	the medical scheme and the managed health care organisation must provide such protocol to health care providers, beneficiaries and members of the public, upon request; and

c)	provision must be made for appropriate exceptions where a protocol has been ineffective or causes or would cause harm to a beneficiary, without penalty to that beneficiary.