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What if I have a complaint against the Society?
Members may lodge complaints in writing to the Society via e-mail (firstname.lastname@example.org) or post (PO Box 1922, Kimberley, 8300) for the attention of the Principal Officer.
All complaints received in writing will be responded to by the Society, in writing, within 30 days of receipt thereof.
Any dispute may be referred to an expert committee for an opinion. A final decision re a dispute taken by the Principal Officer in consultation with the Chairman of the Board, will be binding in terms of the Rules of the Society.
Any member has the right to submit a complaint to the Council for Medical Schemes against the decision of the Principal Officer. Such complaint submitted to the Council needs to be lodged with the Registrar not later than three months after the date on which the decision in question was made by the Principal Officer.
For a detailed process to follow to submit a complaint to the Council for Medical Schemes, please make use of their website www.medicalschemes.com or contact them as per the contact details below.
Laying a complaint with the Council for Medical Schemes (CMS) about the Society
Any beneficiary or any person who is aggrieved by the conduct of a medical scheme can submit a complaint to the CMS. It is however very important to note that a prospective complainant should always first seek to resolve complaints through the complaints mechanisms in place at the respective medical scheme (as noted above in the case of the Society) before approaching the CMS for assistance. Complaints can be submitted by any reasonable means such as a letter, fax, e-mail or in person at the CMS office from Mondays to Fridays during 08:00 – 17:00.
Please access the Council’s website for the complaint form.
The CMS governs the medical schemes industry and therefore your complaint should be related to your medical scheme.
Council for Medical Schemes time limits for dealing with complaints
The CMS aims to provide a transparent, equitable, accessible, expeditious as well as a reasonable and procedurally fair dispute resolution process. The Registrar of the CMS will send a written acknowledgement of a complaint within three working days of its receipt, providing the name, reference number and contact details of the person who will be dealing with a complaint.
In terms of Section 47 of the Medical Schemes Act 131 of 1998, a written complaint received in relation to any matter provided for in that Act will be referred to the medical scheme. The medical scheme is obliged to provide a written response to the Registrar’s Office within 30 days. The Registrar’s Office shall analyse the complaint within four days of receiving the complaint from the member, and refer a complaint to a medical scheme for comments.
Upon receipt of the response from the medical scheme, the Registrar’s Office will analyse the response in order to make a decision or ruling. Decisions/rulings will be made within 120 days of the date of referral of a complaint and communicated to the parties.
The Registrar’s Ruling and appeal to Council
Section 49 of the Act makes provision for any party who is aggrieved by the decision of the Registrar to appeal such a decision. This appeal is at no cost to either of the parties. An appeal must be lodged within 30 days of the date of the decision. The implementation of the decision shall be suspended pending review of the matter by the Council’s Appeal Committee. The secretariat of the Appeals Committee will inform all parties involved of the date and time of the hearing. This notice should be provided no less than 14 days before the date of the hearing. The parties may appear before the Committee and tender evidence or submit written arguments or explanations in person or through a representative. The Appeals Committee may after the hearing confirm or vary the decision concerned or rescind it and give another decision as they see fit.
The section 50 appeals process
Any party that is aggrieved by the decision of the Appeals Committee may appeal to the Appeal Board.
The aggrieved party has 60 days within which to appeal the decision and must submit written arguments or explanations of the grounds of his or her appeal. The Appeal Board shall determine the date, time and venue for the hearing and all parties will be notified in writing. Proceedings of the Appeal Board shall be open to the public unless the chairperson decides otherwise. The Appeal Board shall have the powers which the High Court has to summon witnesses, to cause an oath or affirmation to be administered to them, to examine them, and to call for the production of books, documents and objects. The decisions of the Appeal Board are in writing and a copy thereof shall be furnished to parties.
A prescribed fee of R2 800 is payable by the complainant for Section 50 Appeals.
What if I have a complaint related to other aspects of the health industry?
If you have a complaint related to any other aspect of the health industry, please follow the links below:
- For complaints regarding Health Professionals (doctors) – www.hpcsa.co.za
- For complaints regarding Private Hospitals – www.hasa.co.za
- For complaints regarding Nurses – www.sanc.co.za
- For complaints regarding any other health insurance products – www.osti.co.za (short term insurance ombudsman) or www.ombud.co.za (long term insurance ombudsman)