medical schemes

At Bowman Gilfillan, our experienced practitioners provide clients with sound, practical advice to guide them through the complex and shifting regulatory requirements that affect the medical schemes industry.

The result of more than a decade's worth of rapid development within the industry, and its diverse challenges, have prompted responsible employers, medical schemes, administrators and scheme members, among others, to seek quality legal advice regarding the intricacies of the following:

• scheme governance;
• administration;
• investment and risk strategies;
• reference pricing;    
• managed healthcare;
• scheme consolidation and
• prescribed minimum benefits.
  

The medical schemes industry stands at the threshold of even further development and possible reform with government’s proposed plans to overhaul the national healthcare system over the course of the next five years. The success of industry participants in the months ahead will be closely linked to their ability to display dexterity and clear judgement based on sound knowledge and advice.

services

We strive to give practical, user-friendly advice and legal opinions on:

• Medical scheme governance, administration, investments, compliance, tax, prescribed minimum benefits, curatorship, liquidation, business transfers and amalgamations, post-retirement medical and equitable practice
  
• Drafting rules, amendments, policies, administration agreements, investment mandates, managed healthcare contracts and other service provider contracts
  
• Dispute resolution: mediation, arbitration, litigation in various forums: Council for Medical Schemes, Health Profession Council, Medical Schemes Appeal Board, Labour Court, Equality Court, Competition Commission and High Court
  
• Representations to registrars, tribunals, CMS, Parliament, SARS and NEDLAC
  
• Due diligence into administration, valuations, financial statements, rules, minutes and proposed transfers
  
• Commercial (M&A) advice and drafting involving transfer of fund memberships, medical scheme reserves, consolidation, outsourcing and competition commission filings
  
• Analysis of member and service provider fraud/error reports and forensic legal services

why Bowman Gilfillan?

• Admitted attorneys and qualified, certified effective dispute resolution experts
  
• BEE A rating - 100% procurement spend on our services is recognised
  
• Independence: we have no exclusive relationship with any particular industry participants and regularly act for different stakeholders, including employers, trustees, administrators, consultants, regulators and service providers.
  
• Established relationships in the medical funding regulatory environment and with top specialist counsel
  

Bowman Gilfillan adopted its own Transformation Charter in March 2004, addressing all aspects of transformation, including ownership, human resource development, enterprise development, procurement and corporate social responsibility. Our company has committed itself to train 50 black and 50 female lawyers to partnership level by 2014.

We are the sole South African member of the prestigious Employment Law Alliance (ELA), the world's leading employer orientated alliance, which is made up of firms from all 50 States of the USA and from firms in more than 300 other cities worldwide.

Bowman Gilfillan is also the sole South African representative of Lex Mundi, a global association with more than 160 independent law firms in all major centres across the globe. This association gives our attorneys access to firms that have been identified as the best in each jurisdiction represented.

Our successful track record in South Africa, Southern and East African jurisdictions (including the reputation of our associates, Coulson Harney & Associates in Nairobi) as well as our extensive referral network and relationships in the rest of Africa through the firm's dedicated Africa Group, provide widespread support for all our practise areas.

breakfast with benefits

Keep in touch, up to speed and out of trouble!

You are welcome to join us at one of our regular Breakfast with Benefits seminars. These seminars provide an interactive platform where we share our thoughts and experience on pertinent issues and topical developments in the benefits (pensions and medical) environments. The presentations are short and punchy and time is available for many questions and rigorous debate. If you want to receive an invitation to any of our seminars, please contact our marketing department on +27 11 669 9442 or Hansueya Naidoo on +27 11 669 9565.

articles

Read Bowman Gilfillan healthcare regulatory articles and keep abreast of medical, life and collective investment industry news as it relates to the employment world.

industry updates

We send industry updates to our clients and friends on a regular basis. If you want to receive any of these updates please contact our marketing department on +27 11 669 9442 or Hansueya Naidoo on +27 11 669 9565.

some of our clients

• Afrox Medical Aid Society
• Barloworld Medical Scheme
• Government Employees Medical Scheme
• International SOS
• Massmart Hospitality and General Fund
• Metal Industries Bargaining Fund Administrators
• South African Breweries
• Medical Aid Society
• Transnet
• Ucar
• Witbank Collieries Medical Aid Scheme

the team

Partners

Senior Associate

Associate