The history, origin and membership of RFMCF
According to a former SADF Cabinet Memorandum of ± 1962, the Snyman Commission underwrote a general recommendation of the Reinach Committee that investigated medical assistance schemes, that every recognized medical scheme that provided medical cover should provide for a continuation of those medical privileges to their own pensioners, widows and dependants that they enjoyed whilst serving, through a scheme providing such cover. Specifically relating to the Defence Force, Police and Prisons, it was recommended that each of the three Service Departments had to provide for a continuation of the different medical services that its members were entitled to during their term of service, to their pensioners and widows of deceased members and their dependants.
To implement the recommendation, the Cabinet ordered in 1963 that, concentrating here on further on the Defence Force, an amendment had to be made to the Defence Act, 1957, but that the amendment had to ensure that it did not bind the State to carry the costs of such provision. This was also accepted by the Treasury and that serving members had to make a monetary contribution to ensure that they continue to receive the same quality medical care. Because of the costs of such a service in the private sector being too high and from a practical viewpoint, slotting into the existing military medical organization was proposed where they would be treated on the same basis as serving members and their dependants. To ensure sound financing, the creation of a fund under the control of the State was proposed through which serving members’ contributions could be administered.
According to the said Cabinet Memorandum, the following was the original proposed wording to amend the three Service Acts to authorize the promulgation of regulations:
- “( )bis the medical, dental and hospital treatment of members of the …. Force who retired or retire on pension on or after the first day of January 1964, and their families and of the families of members of the said force who died or die on or after the said date, the conditions on which or circumstances under which they shall be entitled to such treatment and the establishment and management of and control over a fund from which expenses arising from the provision of such treatment may be defrayed;
- ( )ter the deductions for the benefit of the fund established pursuant to paragraph ( )bis from the salaries or wages of members of the ….. Force who, or whose families may become entitled to benefits under regulations made under paragraph ( )bis, and the amounts to be paid into the said fund by members of the said Force who have retired on pension and in respect of whom no such deductions have been made or by their families if they desire to become entitled to such benefits.”According to an analysis provided by Advocates MM Oosthuizen en LJ Gildenhuys on 1 August 2002 containing a juristic framework from a historical perspective about the Fund and the SA Military Health Service (SAMHS) as service provider, they determined that the Defence Act, 1957, had originally been amended on 7 July 1964 through a Government Gazette, from which they made the following deductions:
• That the Minister of Defence was empowered to promulgate regulations for the creation of a fund to ensure that the continuation of medical, dental and hospital treatment for retired members of the Regular Force, being beneficiaries of the Fund, is provided for.
• That the Minister of Defence was also empowered to prescribe that medical benefits had to be provided to continuation members on the same basis that is provided for Regular Force members, provided that the Fund is to carry the cost. Thus, the Minister could create a legal relationship between the Fund and the medical organization of the Surgeon General, the latter of which is to be the preferential service provider to the Fund and the beneficiaries (The Fund could not arrange this itself).
Therefore, the Minister of Defence was legally empowered to establish a detailed self-funding ‘medical scheme’ through regulations and, at the same time, was also permitted to allow that scheme to use the existing military medical facilities of the State.
The enabling legislation led to the formulation of medical regulations that, for the first time, were promulgated on 13 February 1970 as a separate chapter, namely Chapter XV of the General Regulations (GR XV) later amended in 1990, 1991, 1998, 2001 and 2004.
Part IV of GR XV specify the circumstances or conditions under which beneficiaries of the Fund can have access to the medical benefits set out and prescribed in Parts II and III.
The basic theme running throughout all the versions of GR XV from 1970 to the current version promulgated on 31 May 2004, is that there is no direct contractual relationship between a patient under the care and auspices of the Surgeon General and the private sector. This originated from the Defence Act, 1957, and has been retained in Section 82(1)(k) of the revised and current Defence Act, 2002.
The Surgeon General’s involvement is twofold:
- As administrator of health and welfare (which also includes that SG may arrange medical care to a beneficiary of the Fund in the private sector – then the contractual arrangement in this regard is between the SG and the private sector).
- As service provider to the Fund.
Provision exists within GR XV that beneficiaries of the Fund must receive precisely the same
medical benefits that are provided to serving members of the Defence Force.
This means that all members and beneficiaries are patients for purposes of medical care and are to be handled precisely on the same basis. This further means that beneficiaries must be handled as if they have never exited from the Defence Force.
The SG is compelled, as far as is practically possible in seeking treatment for a patient, to first utilize military medical facilities or other State facilities before referring such patient to the private sector. Thus, the SG or the SAMHS is compelled to be the preferential service provider to the Fund and its beneficiaries.
The key role player on an overall basis that has created and is maintaining the above empowering legislation, is the Department of Defence through the Minister of Defence (or vice versa). The Fund as well as its Management Board have received powers of authority as prescribed in the Defence Act and GR XV in managing and securing the Fund. However, neither the Fund nor the Management Board have any provision in terms of which to prescribe or suggest any health service provider to the Department of Defence or the Minister of Defence to be an alternative to the SG or the SAMHS to provide healthcare to its beneficiaries.