Government medical aid to appeal court ruling granting Public Protector jurisdiction over it

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GEMS, which is a medical aid scheme for government employees, will appeal a North Gauteng High Court ruling on Thursday that granted the Public Protector jurisdiction over it.

“We will appeal the North Gauteng High Court ruling and we have already notified the Public Protector’s office of this fact prior to her press statement. We have been advised that we have good grounds for an appeal,” it said in a statement on Tuesday.

“We are confident that the appeal will be favourable to GEMS,” its principal officer, Gunvant Goolab, added.

The Public Protector’s spokesperson, Oupa Segalwe, said whether GEMS did or did not indicate an intention to appeal does not change “the fact that the court ruled in the Public Protector’s favour”.

This comes after the Public Protector praised the High Court ruling in a statement on Monday.

“The ruling paves the way for advocate [Busisiwe] Mkhwebane to carry on with an investigation that was deadlocked for nearly two years, leaving the complainant in the matter in the lurch,” Segalwe explained.

The Public Protector received a complaint by a dependent of a GEMS member alleging it had refused to admit him as the beneficiary after the member’s death.

The person died on June 27, 2013, and was a GEMS member with full benefits, including a subsidy. The complainant’s membership was soon terminated after that by the medical scheme, News24 earlier reported.

ALSO READ: Public Protector praises court for giving it jurisdiction over government medical scheme

The High Court in Pretoria ruled that the case, which is in the interest of the public, should be investigated further to determine whether the complainant was unlawfully excluded from the scheme and if this amounted to improper prejudice on the complainant.

The medical scheme, however, claims that GEMS’ regulatory body, the Council for Medical Schemes (CMS), has already brought the matter to a close.

“The CMS has already investigated the complaint and ruled in GEMS’ favour. The member then appealed this decision, which was dismissed. 

“Given the fact that this complaint has already been investigated and ruled upon by the CMS, it is important that the medical scheme industry obtains clarity on the role of the Public Protector in this already highly regulated industry,” the medical scheme concluded.

The Public Protector’s office said the court was well aware that another body had investigated the matter and it still ruled that the case was of public interest and the Public Protector should carry out her investigation.

“The Public Protector’s investigation has nothing to do with the medical scheme industry but GEMS, which as the court noted, is unique compared to other medical schemes in that it was established by the government for public servants using the public purse to undertake the responsibility of the government as an employer towards its employees,” Segalwe concluded.

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