This regulation is issued to implement Proclamation No. 1273/2022 Community-Based Health Insurance Proclamation. It establishes the framework for managing health insurance pools and reserve funds (Sections 3-6), outlines membership and contribution procedures (Sections 7-9), and details provider payment mechanisms (Section 10). It also addresses fund management, financial deficit coverage (Sections 11-13), and miscellaneous provisions such as co-payment and data management (Sections 14-20).
This Proclamation provides the legal framework for the Community Based Health Insurance System.
Medical Schemes Act No 131 of 1998
The Act consolidates the laws relating to registered medical schemes; provides for the establishment of the Council for Medical Schemes as a juridical entity; provides for the appointment of the Registrar of Medical Schemes; makes provision for the registration and control of certain activities of medical schemes; protects the interests of members of medical schemes; provides for measures for the co-ordination of medical schemes; and provides for incidental matters.