Complaints and disputes procedure

Members may lodge their complaints telephonically, or in writing, to the scheme. The scheme’s dedicated telephone number for dealing with telephonic complaints is 011 208 1005. Call centre agents will assist the member immediately if possible. All unresolved telephonic complaints or complaints received in writing will be responded to by the scheme in writing within 30 days of receipt thereof.

Any dispute, which may arise between a member, prospective member, former member or a person claiming by virtue of such member and the scheme or an officer of the scheme, must be referred by the principal officer to a disputes committee (appointed by the Board of Trustees) for adjudication. On receipt of a request in terms of this rule, the principal officer must convene a meeting of the disputes committee by giving not less than 21 days’ notice in writing to the complainant and all the members of the disputes committee, stating the date, time and venue of the meeting and particulars of the dispute.

The disputes committee may determine the procedure to be followed. The parties to any dispute have the right to be heard at the proceedings, either in person or through a representative.

An aggrieved person has the right to appeal to the Council for Medical Schemes against the decision of the disputes committee. Such appeal must be in the form of an affidavit and directed to Council and shall be furnished to the Registrar not later than three months after the date on which the decision concerned was made. Complaints can be submitted by any reasonable means such as a letter, fax, e-mail or in person at the Council’s Offices from Mondays to Fridays during 08:00 – 17:00. Visit www.medicalschemes.com for more information. See Contacts page for all Council of Medical Schemes contact information.