Guardrisk Insurance Company Limited v Registrar of Medical Schemes and Another

Guardrisk Insurance Company Limited, a registered short-term insurer under the Short Term Insurance Act 53 of 1998, marketed and sold two insurance products known as AdmedGap and AdmedPulse. These policies provided monetary benefits to insured persons when they incurred certain hospitalisation and specified medical treatment costs, calculated as the difference between providers’ charges and the National Health Reference Price List, subject to caps. The Registrar and Council for Medical Schemes obtained an interdict in the High Court prohibiting Guardrisk from selling these products on the basis that they constituted the ‘business of a medical scheme’ under the Medical Schemes Act 131 of 1998, for which Guardrisk was not registered. Guardrisk appealed to the Supreme Court of Appeal.

The appeal was upheld with costs, including the costs of two counsel. The High Court order granting an interdict was set aside and replaced with an order dismissing the application with costs.

The case is significant for clarifying the boundary between health-related insurance products and the regulated business of medical schemes in South Africa. It provides authoritative guidance on statutory interpretation, particularly the use of ‘and’ versus ‘or’, and affirms a harmonious reading of the Medical Schemes Act and the Short Term Insurance Act. The decision enabled the continued offering of gap-cover insurance products without requiring registration as medical schemes.