RulesIndex 16.1 MEMBERs are entitled to benefits during a financial year, as per Annexure B, and such benefits extend through the MEMBER to his registered DEPENDANTs. 16.2 The SOCIETY shall, where an account has been rendered, pay any benefit due to a MEMBER, either to that MEMBER or to the supplier of the Relevant Health Service who rendered the account, within 30 days of receipt of the claim pertaining to such benefit. 16.3 Any benefit in Annexure B covers the cost of services rendered in respect of the PRESCRIBED MINIMUM BENEFITS, in accordance with Appendix 1. 16.4 No limitations or exclusions will be applied to the PRESCRIBED MINIMUM BENEFITS. 16.5 The SOCIETY has excluded certain services from benefits as set out in Annexure C hereto. 16.6 The Board shall not authorise payment for services other than those provided for in these rules but may, in its absolute discretion and on such terms and conditions as it may determine, make ex-gratia payments.
17.1 The SOCIETY may pay the full amount claimed by a supplier of services direct to that supplier and then recover the difference between the amount so paid and the benefit entitlement from the MEMBER. 17.2 The SOCIETY may, whether by agreement or not with any supplier or group of suppliers of a service, pay the benefit to which the MEMBER is entitled, directly to the supplier who rendered the service. 17.3 Where the SOCIETY has paid an account or portion of an account or any benefit to which a MEMBER is not entitled, whether payment is made to the MEMBER or to the supplier of service, the amount of any such overpayment is recoverable by the SOCIETY. 17.4 Notwithstanding the provisions of this rule, the SOCIETY has the right to pay any benefit directly to the MEMBER concerned.
18.1 The affairs of the SOCIETY must be managed according to these rules by a BOARD consisting of at least eight persons who are fit and proper to be trustees. 18.2 At least half of such trustees must be elected by MEMBERs from amongst MEMBERs to serve terms of office of three years each and the EMPLOYER shall appoint the remaining TRUSTEES at its sole discretion. 18.3 The following persons are not eligible to serve as members of the BOARD: 18.3.1 a person under the age of 21 years; 18.3.2 an employee of the Society; 18.3.3 the principal officer of the SOCIETY; and 18.3.4 the AUDITOR of the SOCIETY.
18.4 Retiring members of the Board, who were elected by members, are eligible for re-election provided no person shall serve more than a total of three terms. 18.5 Nominations of member elected Trustees to the BOARD must be signed by the candidate signifying his consent to stand for election, must be submitted to the SOCIETY by 15 November each election year and a general election must be held by the MEMBERs. 18.6 The BOARD may fill by appointment by the remaining members of the BOARD, any casual vacancy, which occurs during its term of office by the candidate obtaining the next highest number of votes in the region for which the vacancy occurred. A person so appointed must fill the vacancy for the unexpired period of office of the vacating member of the BOARD; 18.7 The BOARD may co-opt a knowledgeable person to assist it in it’s deliberations provided that such person shall not have a vote. 18.8 The Board may, subject to participation by sufficient members to form a quorum, discuss and resolve matters by telephone or electronic conferencing means and may adopt resolutions on that basis. 18.9 Half of the members of the BOARD plus one is a quorum at meetings of the BOARD. 18.10 The BOARD shall elect the chairperson and vice-chairperson of the BOARD. 18.11 In the absence of the chairperson and vice-chairperson, the BOARD members present must elect one of their numbers to preside. 18.12 Matters serving before the BOARD must be decided by a majority vote and the chairperson shall not have a casting vote in addition to his deliberative vote. 18.13 A member of the BOARD may resign at any time by giving written notice to the BOARD. 18.14 A member of the BOARD ceases to hold office if — 18.14.1 he becomes mentally ill or incapable of managing his affairs; 18.14.2 he is declared insolvent or has surrendered his estate for the benefit of his creditors; 18.14.3 he is convicted, whether in the Republic or elsewhere, of theft, fraud, forgery or uttering of a forged document or perjury; 18.14.4 he is removed by the court from any office of trust on account of misconduct; 18.14.5 he is disqualified under any law from carrying on his profession; 18.14.6 he ceases to be an appointee by the EMPLOYER, or being a BOARD member elected by MEMBERs of the SOCIETY, he ceases to be a MEMBER of the SOCIETY; 18.14.7 he absents himself from three consecutive meetings of the BOARD without the permission of the chairperson; or 18.14.8 he is removed from office by the COUNCIL in terms of Section 46 of the ACT. 18.14.9 The provisions of rules 18.14.1 – 18.14.5 apply mutatis mutandis to the principal officer.
18.15 The BOARD must meet at least once every three months or at such intervals as it may deem necessary. 18.16 The chairperson may convene a special meeting should the necessity arise. Any three members of the BOARD may request the chairperson to convene a special meeting of the BOARD, stating the matters to be discussed at such meeting. 18.17 Members of the BOARD may be reimbursed for all reasonable expenses incurred by them in the performance of their duties as trustees. 18.18 Members of the BOARD who have been elected by the MEMBERs and who have retired on pension may be remunerated as determined from time to time at the annual general meeting.
19.1 The BOARD is responsible for the proper and sound management of the SOCIETY, in terms of these rules. 19.2 The BOARD must act with due care, diligence, skill and in good faith. 19.3 Members of the BOARD must avoid conflicts of interests, and must declare any interest they may have in any particular matter serving before the BOARD. 19.4 The BOARD must apply sound business principles and ensure the financial soundness of the SOCIETY. 19.5 The BOARD shall appoint a principal officer who is fit and proper to hold such office and may appoint any staff which in its opinion are required for the proper execution of the business of the SOCIETY, and shall determine the terms and conditions of service of the principal officer and of any person employed by the SOCIETY. 19.6 The chairperson must preside over meetings of the BOARD and ensure due and proper conduct at meetings. 19.7 The BOARD must cause to be kept such minutes, accounts, entries, registers and records as are essential for the proper functioning of the SOCIETY. 19.8 The BOARD must ensure that proper control systems are employed by and on behalf of the SOCIETY. 19.9 The BOARD must ensure that adequate and appropriate information is communicated to the MEMBERs regarding their rights, benefits, CONTRIBUTIONs and duties in terms of the rules. 19.10 The BOARD must take all reasonable steps to ensure that CONTRIBUTIONs are paid timeously to the SOCIETY in accordance with the ACT and the rules. 19.11 The BOARD must take out and maintain an appropriate level of professional indemnity insurance and fidelity guarantee insurance. 19.12 The BOARD must obtain expert advice on legal, accounting and business matters as required, or on any other matter of which the members of the BOARD may lack sufficient expertise. 19.13 The BOARD must ensure that the rules and the operation and administration of the SOCIETY comply with the provisions of the ACT and all other applicable laws. 19.14 The BOARD must take all reasonable steps to protect the confidentiality of medical records concerning any MEMBER or DEPENDANT’s state of health. 19.15 The BOARD must approve all disbursements. 19.16 The BOARD must cause to be kept in safe custody, in a safe or strong room at the registered office of the SOCIETY or with any financial institution approved by the BOARD, any mortgage bond, title deed or other security belonging to or held by the SOCIETY, except when in the temporary custody of another person for the purposes of the SOCIETY. 19.17 The BOARD must make such provision as it deems desirable, and with due regard to normal practice and recommended guidelines pertaining to retention of documents, for the safe custody of the books, records, documents and other effects of the SOCIETY. 19.18 The BOARD shall disclose annually in writing to the REGISTRAR, any payment or considerations made to them in that particular year by the SOCIETY.
The BOARD has the power — 20.1 to cause the termination of the services of any employee of the SOCIETY’s staff; 20.2 to take all necessary steps and to sign and execute all necessary documents to ensure and secure the due fulfillment of the SOCIETY's obligations. 20.3 to delegate any of its powers and duties to another person including, but not limited to - 20.3.1 a sub-committee of the BOARD comprising one or more members of the BOARD and such other persons, as the BOARD may decide; 20.3.2 an expert 20.3.3 an employee of the SOCIETY; 20.3.4 a service provider including, but not limited to an administrator, asset manager and an investment consultant,
on the conditions that -
20.3.5 no functions which in law are required to be performed by the BOARD itself may be delegated; 20.3.6 the BOARD may impose conditions and limitations on the delegation of any power and/or function to any person; 20.3.7 a decision of the delagee must be recorded in the minutes of the next meeting of the BOARD and will be regarded as a decision of the SOCIETY. 20.3.8 the BOARD will retain full responsibility for any decision by a delagee to whom the BOARD'S decision making powers have been delegated in terms of this rule. 20.4 to appoint a duly accredited administrator on such terms and conditions as it may determine, for the proper execution of the business of the SOCIETY. The terms and conditions of such appointment must be contained in a written contract, which complies with the requirements of the ACT and the regulations; 20.5 to contract with managed health care organisations subject to the provisions of the ACT and its regulations; 20.6 to purchase movable and immovable property for the use of the SOCIETY or otherwise, and to sell it or any of it; 20.7 to let or hire movable or immovable property; 20.8 to provide administration services to other medical schemes as an accredited third party administrator; 20.9 in respect of any monies not immediately required to meet current charges upon the SOCIETY and subject to the provisions of the ACT, and in the manner determined by the BOARD, to invest or otherwise deal with such moneys upon security and to realise, re-invest or otherwise deal with such monies and investments; 20.10 with the prior APPROVAL of the COUNCIL, to borrow money for the SOCIETY from the SOCIETY's bankers against the security of the SOCIETY's assets for the purpose of bridging a temporary shortage; 20.11 subject to the provisions of any law, to cause the SOCIETY, whether on its own or in association with any person, to establish or operate any pharmacy, hospital, clinic, maternity home, nursing home, infirmary, home for aged persons or any similar institution, in the interests of the MEMBERs of the SOCIETY; 20.12 to donate to any hospital, clinic, nursing home, maternity home, infirmary or home for aged persons in the interests of all or any of the BENEFICIARIES; 20.13 to grant repayable loans to MEMBERs or to make ex gratia payments on behalf of MEMBERs in order to assist such MEMBERs to meet commitments in regard to any matter specified in rule 5; 20.14 to contribute to any fund conducted for the benefit of employees of the SOCIETY; 20.15 to reinsure obligations in terms of the benefits provided for in these rules; 20.16 to authorise the principal officer and /or such members of the BOARD as it may determine from time to time, and upon such terms and conditions as the BOARD may determine, to sign any contract or other document binding or relating to the SOCIETY or any document authorising the performance of any act on behalf of the SOCIETY; 20.17 to contribute to any association instituted for the furtherance, encouragement and co-ordination of medical schemes; 20.18 in general, do anything, which it deems necessary or expedient to perform its functions in accordance with the provisions of the ACT and these rules.
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