{"id":12226,"date":"2023-12-13T15:02:00","date_gmt":"2023-12-13T13:02:00","guid":{"rendered":"https:\/\/medicalaid.com\/?page_id=12226"},"modified":"2023-12-14T13:46:31","modified_gmt":"2023-12-14T11:46:31","slug":"how-to-report-medical-scheme-wrongdoing","status":"publish","type":"page","link":"https:\/\/medicalaid.com\/medical-aids\/how-to-report-medical-scheme-wrongdoing\/","title":{"rendered":"How to Report a Medical Aid Scheme for Wrongdoing"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"12226\" class=\"elementor elementor-12226\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"has_ae_slider elementor-section elementor-top-section elementor-element elementor-element-3621d160 elementor-section-boxed elementor-section-height-default elementor-section-height-default ae-bg-gallery-type-default\" data-id=\"3621d160\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-50215c77 ae-bg-gallery-type-default\" data-id=\"50215c77\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0abb8dc elementor-widget elementor-widget-image\" data-id=\"0abb8dc\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1201\" height=\"631\" src=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/06\/How-to-Report-a-Medical-Aid-Scheme-for-Wrongdoing-2.jpg\" class=\"attachment-full size-full wp-image-19860\" alt=\"\" srcset=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/06\/How-to-Report-a-Medical-Aid-Scheme-for-Wrongdoing-2.jpg 1201w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/06\/How-to-Report-a-Medical-Aid-Scheme-for-Wrongdoing-2-300x158.jpg 300w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/06\/How-to-Report-a-Medical-Aid-Scheme-for-Wrongdoing-2-1024x538.jpg 1024w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/06\/How-to-Report-a-Medical-Aid-Scheme-for-Wrongdoing-2-768x404.jpg 768w\" sizes=\"(max-width: 1201px) 100vw, 1201px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5a87a160 elementor-widget elementor-widget-heading\" data-id=\"5a87a160\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h1 class=\"elementor-heading-title elementor-size-default\">How to report a medical aid scheme for wrongdoing<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3758c053 elementor-widget elementor-widget-text-editor\" data-id=\"3758c053\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p><strong>How to report a medical aid scheme for wrongdoing in South Africa revealed<\/strong>.<\/p><p>We <b>verified how to report a medical aid scheme for wrongdoing <\/b>in South Africa.<\/p><p>This is a <strong>complete<\/strong> guide to reporting a medical aid scheme for wrongdoing.<\/p><p>In this in-depth guide you\u2019ll learn:<\/p><ul><li>What is a <strong>Medical Aid Scheme?<\/strong><\/li><li>What is the medical <strong>ombudsman<\/strong>?<\/li><li>What is the <strong>council<\/strong> for medical schemes?<\/li><li>What are the <strong>medical board complaints?<\/strong><\/li><li>When should you <strong>report<\/strong> medical aid wrongdoing?<\/li><li><strong>Where<\/strong> do you report medical aid for wrongdoing?<\/li><\/ul><p><br \/>So if you\u2019re ready to go \u201call in\u201d with <strong>reporting a medical aid scheme for wrongdoing\u00a0in South Africa<\/strong>, this guide is for you.<\/p><p>Let\u2019s dive right in\u2026<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ae_slider elementor-section elementor-top-section elementor-element elementor-element-489a7803 elementor-section-boxed elementor-section-height-default elementor-section-height-default ae-bg-gallery-type-default\" data-id=\"489a7803\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1e11d53 ae-bg-gallery-type-default\" data-id=\"1e11d53\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-46740a9e elementor-widget elementor-widget-text-editor\" data-id=\"46740a9e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<h3>How to report a medical aid scheme for wrongdoing Summary<\/h3><div class=\"elementor-toc__list-item-text-wrapper\"><div class=\"elementor-toc__list-item-text-wrapper\"><ol class=\"elementor-toc__list-wrapper\"><li class=\"elementor-toc__list-item\"><div class=\"elementor-toc__list-item-text-wrapper\"><a class=\"elementor-toc__list-item-text elementor-toc__top-level\" href=\"https:\/\/medicalaid.com\/medical-aids\/how-to-report-medical-scheme-wrongdoing\/#elementor-toc__heading-anchor-1\">\u2705\u00a0 How medical schemes are governed in South Africa<\/a><\/div><\/li><li class=\"elementor-toc__list-item\"><div class=\"elementor-toc__list-item-text-wrapper\"><a class=\"elementor-toc__list-item-text elementor-toc__top-level\" href=\"https:\/\/medicalaid.com\/medical-aids\/how-to-report-medical-scheme-wrongdoing\/#elementor-toc__heading-anchor-1\">\u2705\u00a0 <\/a><a class=\"elementor-toc__list-item-text elementor-toc__top-level\" href=\"https:\/\/medicalaid.com\/medical-aids\/how-to-report-medical-scheme-wrongdoing\/#elementor-toc__heading-anchor-2\">The Medical Schemes Act 131 of 1998<\/a><\/div><\/li><li class=\"elementor-toc__list-item\"><div class=\"elementor-toc__list-item-text-wrapper\"><a class=\"elementor-toc__list-item-text elementor-toc__top-level\" href=\"https:\/\/medicalaid.com\/medical-aids\/how-to-report-medical-scheme-wrongdoing\/#elementor-toc__heading-anchor-1\">\u2705\u00a0 <\/a><a class=\"elementor-toc__list-item-text elementor-toc__top-level\" href=\"https:\/\/medicalaid.com\/medical-aids\/how-to-report-medical-scheme-wrongdoing\/#elementor-toc__heading-anchor-3\">How one can report the conduct of a medical scheme<\/a><\/div><\/li><li class=\"elementor-toc__list-item\"><div class=\"elementor-toc__list-item-text-wrapper\"><a class=\"elementor-toc__list-item-text elementor-toc__top-level\" href=\"https:\/\/medicalaid.com\/medical-aids\/how-to-report-medical-scheme-wrongdoing\/#elementor-toc__heading-anchor-4\">The Complaints Procedure<\/a><\/div><\/li><li class=\"elementor-toc__list-item\"><div class=\"elementor-toc__list-item-text-wrapper\"><a class=\"elementor-toc__list-item-text elementor-toc__top-level\" href=\"https:\/\/medicalaid.com\/medical-aids\/how-to-report-medical-scheme-wrongdoing\/#elementor-toc__heading-anchor-7\">Everything you need to know about the \u201cMedical Aid Ombudsman\u201d<\/a><\/div><\/li><li class=\"elementor-toc__list-item\"><div class=\"elementor-toc__list-item-text-wrapper\"><a class=\"elementor-toc__list-item-text elementor-toc__top-level\" href=\"https:\/\/medicalaid.com\/medical-aids\/how-to-report-medical-scheme-wrongdoing\/#elementor-toc__heading-anchor-8\">FAQ<\/a><\/div><\/li><\/ol><\/div><\/div>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ae_slider elementor-section elementor-top-section elementor-element elementor-element-5824d22e elementor-section-boxed elementor-section-height-default elementor-section-height-default ae-bg-gallery-type-default\" data-id=\"5824d22e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-72e34e7a ae-bg-gallery-type-default\" data-id=\"72e34e7a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-251b0459 elementor-widget elementor-widget-text-editor\" data-id=\"251b0459\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<h2>How medical schemes are governed in South Africa<\/h2><p><img decoding=\"async\" class=\"aligncenter wp-image-9725 size-full\" title=\"How medical schemes are governed in South Africa\" src=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Familiarise-yourself-with-the-fine-print-scaled.jpg\" alt=\"How medical schemes are governed in South Africa\" width=\"2560\" height=\"1439\" srcset=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Familiarise-yourself-with-the-fine-print-scaled.jpg 2560w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Familiarise-yourself-with-the-fine-print-300x169.jpg 300w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Familiarise-yourself-with-the-fine-print-1024x575.jpg 1024w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Familiarise-yourself-with-the-fine-print-768x432.jpg 768w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Familiarise-yourself-with-the-fine-print-1536x863.jpg 1536w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Familiarise-yourself-with-the-fine-print-2048x1151.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/><\/p><p>\ud83d\udc49 In accordance with the Medical Schemes Act (131 of 1998), the Council for Medical Schemes is a statutory entity that was established for the purpose of providing regulatory supervision of private health funding carried out through medical schemes.<\/p><p>\ud83d\udc49 The <strong>Minister of Health<\/strong> is the one who appoints the members of the board, which includes a Non-executive Chairman, Deputy Chairman, and 13 other members. This board is responsible for the governance of the Council.<\/p><p>\ud83d\udc49 According to the <a title=\"The Medical Aid Act - The Ultimate Guide\" href=\"https:\/\/medicalaid.com\/medical-aids\/medical-aid-act-guide\/\">Medical Schemes Act<\/a>, the Minister is also responsible for appointing the Registrar, who serves as the executive head of the Council. The Registrar and the Executive Managers are responsible for making day-to-day decisions as well as managing the personnel. The Council is responsible for setting general policy.<\/p><p>\ud83d\udc49 The Council is responsible for overseeing a huge and critically significant industry that is comprised of over 80 <strong>medical plans<\/strong> that are registered in the country.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ae_slider elementor-section elementor-top-section elementor-element elementor-element-1b159195 elementor-section-boxed elementor-section-height-default elementor-section-height-default ae-bg-gallery-type-default\" data-id=\"1b159195\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-30daea37 ae-bg-gallery-type-default\" data-id=\"30daea37\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-78335ca7 elementor-widget elementor-widget-text-editor\" data-id=\"78335ca7\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<h2>The Medical Schemes Act 131 of 1998<\/h2><p><img decoding=\"async\" class=\"aligncenter wp-image-9711 size-full\" title=\"The Medical Schemes Act 131 of 1998\" src=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Use-your-medical-aid-in-an-efficient-way-scaled.jpg\" alt=\"The Medical Schemes Act 131 of 1998\" width=\"2560\" height=\"1707\" srcset=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Use-your-medical-aid-in-an-efficient-way-scaled.jpg 2560w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Use-your-medical-aid-in-an-efficient-way-300x200.jpg 300w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Use-your-medical-aid-in-an-efficient-way-1024x683.jpg 1024w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Use-your-medical-aid-in-an-efficient-way-768x512.jpg 768w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Use-your-medical-aid-in-an-efficient-way-1536x1024.jpg 1536w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Use-your-medical-aid-in-an-efficient-way-2048x1365.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/><\/p><p>\ud83d\udc49 The <strong>Medical Schemes Act<\/strong> has the following purposes:<\/p><p>\u27a1\ufe0f To bring together the laws that pertain to registered medical schemes;<\/p><p>\u27a1\ufe0f To make provision for the establishment of the <a title=\"A Closer Look at the Council for Medical Schemes\" href=\"https:\/\/medicalaid.com\/medical-aids\/council-for-medical-schemes\/\">Council for Medical Schemes<\/a> as a juristic person;<\/p><p>\u27a1\ufe0f To make provision for the appointment of the Registrar of Medical Schemes;<\/p><p>\u27a1\ufe0f To make provision for the registration and control of certain activities of medical schemes;<\/p><p>\u27a1\ufe0f To protect the interests of members of medical schemes;<\/p><p>\u27a1\ufe0f To make provision for measures for the coordination of medical schemes;<\/p><p>\u27a1\ufe0f To make provision for incidental medical matters.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ae_slider elementor-section elementor-top-section elementor-element elementor-element-6bcf892d elementor-section-boxed elementor-section-height-default elementor-section-height-default ae-bg-gallery-type-default\" data-id=\"6bcf892d\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-220e18 ae-bg-gallery-type-default\" data-id=\"220e18\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3e135119 elementor-widget elementor-widget-text-editor\" data-id=\"3e135119\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<h2>How one can report the conduct of a medical scheme<\/h2><p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-12205 size-full\" title=\"How one can report the conduct of a medical scheme\" src=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Downgrade-your-plan-if-necessary-2-scaled.jpg\" alt=\"How one can report the conduct of a medical scheme\" width=\"2560\" height=\"1709\" srcset=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Downgrade-your-plan-if-necessary-2-scaled.jpg 2560w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Downgrade-your-plan-if-necessary-2-300x200.jpg 300w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Downgrade-your-plan-if-necessary-2-1024x684.jpg 1024w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Downgrade-your-plan-if-necessary-2-768x513.jpg 768w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Downgrade-your-plan-if-necessary-2-1536x1025.jpg 1536w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Downgrade-your-plan-if-necessary-2-2048x1367.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/><\/p><p>\ud83d\udc49 <a title=\"Worst Medical Aids in South Africa\" href=\"https:\/\/medicalaid.com\/medical-aids\/worst-medical-aids-in-south-africa\/\" target=\"_blank\" rel=\"noopener\">Complaints<\/a> about the conduct of a medical scheme can be filed by anybody, including beneficiaries of a medical plan as well as anyone else who is dissatisfied with the way the plan was administered.<\/p><p>\ud83d\udc49 Because the Council for Medical Schemes (CMS) is the governing body for the industry of medical schemes, your complaint ought to be directly related to the actions or performance of your medical scheme.<\/p><p>\ud83d\udc49 A very important point to keep in mind is to always make an effort to settle the problem through the complaints mechanisms that are in place at the medical scheme in question before turning to the Council for help.<\/p><p style=\"text-align: center;\">Learn more about <a title=\"Dis-Chem Health - Medical Insurance\" href=\"https:\/\/medicalaid.com\/health-insurance\/dischem\/\" target=\"_blank\" rel=\"noopener\">Dischem Medical Aid Plans<\/a><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ae_slider elementor-section elementor-top-section elementor-element elementor-element-71619f0b elementor-section-boxed elementor-section-height-default elementor-section-height-default ae-bg-gallery-type-default\" data-id=\"71619f0b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c62e2b8 ae-bg-gallery-type-default\" data-id=\"c62e2b8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2a6eb0b6 elementor-widget elementor-widget-text-editor\" data-id=\"2a6eb0b6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<h2>The Complaints Procedure<\/h2><p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-12213 size-full\" title=\"The Complaints Procedure\" src=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Conduct-a-plan-comparison-2-scaled.jpg\" alt=\"The Complaints Procedure\" width=\"2560\" height=\"1706\" srcset=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Conduct-a-plan-comparison-2-scaled.jpg 2560w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Conduct-a-plan-comparison-2-300x200.jpg 300w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Conduct-a-plan-comparison-2-1024x683.jpg 1024w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Conduct-a-plan-comparison-2-768x512.jpg 768w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Conduct-a-plan-comparison-2-1536x1024.jpg 1536w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/Conduct-a-plan-comparison-2-2048x1365.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/><\/p><p>\ud83d\udc49 To file a complaint with the CMS, you can simply complete out the form that can be found on their website and submit the complaint manually or online.<\/p><h3>How to submit a complaint manually<\/h3><p>\ud83d\udc49 To submit a manual complaint, you can download the form from the council\u2019s website (<a title=\"The Complaints Procedure - Council for Medical Schemes\" href=\"https:\/\/www.medicalschemes.co.za\/consumer-assistance\/complaintsprocedure\" target=\"_blank\" rel=\"nofollow noopener\">https:\/\/www.medicalschemes.co.za\/consumer-assistance\/complaintsprocedure<\/a>) and submit it together with all available supporting documents to complaints@medicalschemes.co.za.<\/p><p>\ud83d\udc49 You can also post it to The Council for Medical Schemes: Complaints Unit, Private Bag X34, Hatfield, 0028.<\/p><h3>Time limits for complaints<\/h3><p>\ud83d\udc49 The council\u2019s aim is to serve the beneficiaries of medical schemes and the public by investigating and resolving complaints in an effective and efficient manner. By doing this, it ensures that beneficiaries are treated fairly by their medical schemes.<\/p><p>\ud83d\udc49 Within three business days of receiving a complaint, the Registrar&#8217;s Office will send a formal acknowledgement of the complaint. This acknowledgement will include the name, reference number, and contact information of the person who will be handling the complaint.<\/p><p>\ud83d\udc49 Within four business days of acknowledging the complaint, the Registrar&#8217;s Office is required to conduct an analysis of the complaint and then submit the matter to the regulated entity for comments.<\/p><p>\ud83d\udc49 A written complaint that is received with respect to any topic that is provided for in this Act will be sent to the regulated entity so that they can provide a written response in accordance with the provisions of Section 47 of the Medical Schemes Act 131 of 1998.<\/p><p>\ud83d\udc49 Within a month after receiving the complaint, the party that is the subject of the complaint is required to provide a written answer to the Registrar&#8217;s Office.<\/p><p>\ud83d\udc49 If the Registrar is presented with convincing evidence that explains why the 30-day deadline could not be met, they have the authority to extend the deadline. Following the receipt of the response, the Registrar&#8217;s Office will do an analysis of the response, as well as acquire the needed evidence and carry out all of the necessary investigations, in order to guarantee a judgement or conclusion that is fair and balanced.<\/p><p>\ud83d\udc49 Within one hundred and twenty workdays after receiving all of the pertinent material and proof, decisions and rulings will be issued and conveyed to the parties.<\/p><p>\ud83d\udc49 In the event that this deadline is unable to be fulfilled due to the complexity of investigations, the Registrar will make every effort to keep complainants informed of developments and the reasons for the delay in resolving the issue.<\/p><p>\u00a0<\/p><p style=\"text-align: center;\">READ ALSO: <a title=\"Best Medical Aids for Small Businesses\" href=\"https:\/\/medicalaid.com\/medical-aids\/medical-aids-for-small-businesses\/\" target=\"_blank\" rel=\"noopener\">Best Medical Aids for Small Businesses<\/a><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ae_slider elementor-section elementor-top-section elementor-element elementor-element-1cdad9ca elementor-section-boxed elementor-section-height-default elementor-section-height-default ae-bg-gallery-type-default\" data-id=\"1cdad9ca\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-74a23810 ae-bg-gallery-type-default\" data-id=\"74a23810\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7d8ed202 elementor-widget elementor-widget-text-editor\" data-id=\"7d8ed202\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<h2>Everything you need to know about the \u201cMedical Aid Ombudsman\u201d<\/h2><p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-9340 size-full\" title=\"Everything you need to know about the \u201cMedical Aid Ombudsman\u201d\" src=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/What-Is-a-Medical-Aid-scaled.jpg\" alt=\"Everything you need to know about the \u201cMedical Aid Ombudsman\u201d\" width=\"2560\" height=\"1707\" srcset=\"https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/What-Is-a-Medical-Aid-scaled.jpg 2560w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/What-Is-a-Medical-Aid-300x200.jpg 300w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/What-Is-a-Medical-Aid-1024x683.jpg 1024w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/What-Is-a-Medical-Aid-768x512.jpg 768w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/What-Is-a-Medical-Aid-1536x1024.jpg 1536w, https:\/\/medicalaid.com\/wp-content\/uploads\/2023\/04\/What-Is-a-Medical-Aid-2048x1365.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/><\/p><p>\ud83d\udc49 The <strong>medical aid ombudsman<\/strong> is a body that individuals can approach for redress concerning a variety of concerns that pertain to their <a title=\"10 Best Medical Aid Schemes In South Africa\" href=\"https:\/\/medicalaid.com\/medical-aids\/best-medical-aid-schemes\/\" target=\"_blank\" rel=\"noopener\">medical aid scheme<\/a> or service provider, as well as any other issue that is associated with their medical aid.<\/p><p>\ud83d\udc49 This can also include the final service providers that are either contracted through that particular medical aid or who are a part of the medical aid system in question.<\/p><p>\ud83d\udc49 One further way to think about the medical aid ombudsman is as a kind of big brother who is there to look out for your best interests and make sure that any problems that arise with your medical insurance plan are resolved in a way that is above board, legal, and ethical.<\/p><p>\ud83d\udc49 In this role, the medical aid ombudsman will make sure that any concerns that arise may be resolved. In the past, there was not a designated medical ombudsman in the same manner that there were other ombudsmen in place to handle other concerns such as misuse or abuse of authority, government corruption, and so on.<\/p><p>\ud83d\udc49 In this way, the Medical Aid Scheme Council of South Africa serves in a role similar to that of a collective <strong>ombudsman<\/strong>.<\/p><p>\ud83d\udc49 It is an extremely important body because it basically has to oversee and regulate around ninety-seven or so medical aid scheme service providers operating in South Africa, collectively over eight million beneficiaries, and this entire industry is worth billions of rand.<\/p><p>\ud83d\udc49 The Council for medical schemes is the governing body of all of South Africa&#8217;s medical aid schemes and service providers. With such a vast business there is a very evident need to have an all-encompassing regulating organisation in place to ensure that all is above board and that beneficiaries have legal redress in the form of the council for medical plans.<\/p><p>\ud83d\udc49 This is basically the closest thing there is to a <strong>medical aid ombudsman<\/strong>, and it is actually a very successful and well-organized agency.<\/p><p>\ud83d\udc49 You could be wondering how exactly this council for medical plans can be of use to you at this point, and the response is actually fairly straightforward and easy to understand. Because of the way that the council is established, it is possible for anyone who has a grievance regarding their medical assistance programme to go to the council in order to seek some form of redress.<\/p><p>\ud83d\udc49 There is no limitation or specification as to the kinds of problems that a person can complain about or seek remedy over, thus virtually any problem that you may have can be brought to the council&#8217;s attention for resolution.<\/p><p>\ud83d\udc49 If you are feeling aggrieved by your medical aid service provider, then you should approach the council.<\/p><p style=\"text-align: center;\">You might like <a title=\"Medical Aid Tax Credit Explained\" href=\"https:\/\/medicalaid.com\/medical-aids\/medical-aid-tax-credit\/\"><strong>Medical Aid Tax Credit Explained in South Africa<\/strong><\/a><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ae_slider elementor-section elementor-top-section elementor-element elementor-element-31095757 elementor-section-boxed elementor-section-height-default elementor-section-height-default ae-bg-gallery-type-default\" data-id=\"31095757\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1305dc12 ae-bg-gallery-type-default\" data-id=\"1305dc12\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-49c78ff elementor-widget elementor-widget-text-editor\" data-id=\"49c78ff\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<h2>Frequently Asked Questions<\/h2><p>\u00a0<\/p><h3>Where can I report a medical scheme in South Africa?<\/h3><p>To report wrongdoing or complaints regarding a medical aid scheme in South Africa, you can contact the Council for Medical Schemes (CMS). The CMS is the regulatory body responsible for overseeing medical schemes in the country<\/p><p>\u00a0<\/p><h3>How can you report your medical aid if you are unhappy about its actions?<\/h3><p>Before approaching the Council for assistance, a potential complainant should always make an effort to settle their problem through the complaints mechanisms that are in place at the medical scheme in question before turning to the Council for help.\u00a0To file a complaint with the CMS, simply complete out the form that can be found on their website.<\/p><p>\u00a0<\/p><h3>How do you report a medical aid complaint in writing?<\/h3><p>When you report a complaint in writing, you need to include the following information in your Letter:<\/p><ul><li>An address and contact detail where you can be reached<\/li><li>Your email address, if sending by email<\/li><li>The important dates relevant to the issue<\/li><li>Give the basic facts for your complaint in a short, factual summary<\/li><li>Attach any documents you may have as evidence<\/li><li>Tell the council how you already tried to resolve the problem.<\/li><li>Be reasonable.<\/li><li>File your complaint.<\/li><\/ul><h3>\u00a0<\/h3><h3>In what ways can you contact the medical Ombudsman?<\/h3><p>You can contact the medical ombudsman on Toll-Free Number 080 911 6472; Fax 086 560 4157; email complaints@ohsc.org.za, post Private Bag X 21, Arcadia, Pretoria, 0007, or walk-in at OHSC Offices, 79 Steve Biko Road, Prinshof, Pretoria.<\/p><p>\u00a0<\/p><h3>What can you do if your medical aid refuses to pay a claim?<\/h3><p>If your medical aid refuses to pay a claim, you can ask your doctor to provide a motivation with valid reasons as to why the treatment is necessary. In certain cases, a medical aid may then reconsider covering the treatment in question. You can collect a motivation letter from your doctor and send it through to the scheme so that their medical panel can reconsider the decision.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ae_slider elementor-section elementor-top-section elementor-element elementor-element-47718426 elementor-section-boxed elementor-section-height-default elementor-section-height-default ae-bg-gallery-type-default\" data-id=\"47718426\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6707b1cd ae-bg-gallery-type-default\" data-id=\"6707b1cd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6e419942 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.elementor-toc__list-wrapper{margin-top:.5em;margin-inline-start:var(--nested-list-indent,1em)}.elementor-toc__list-item-text{transition-duration:var(--item-text-transition-duration)}.elementor-toc__list-item-text:hover{color:var(--item-text-hover-color);-webkit-text-decoration:var(--item-text-hover-decoration);text-decoration:var(--item-text-hover-decoration)}.elementor-toc__list-item-text.elementor-item-active{color:var(--item-text-active-color);-webkit-text-decoration:var(--item-text-active-decoration);text-decoration:var(--item-text-active-decoration)}.elementor-toc__list-item-text-wrapper{display:flex;align-items:center}.elementor-toc__list-item-text-wrapper:before,.elementor-toc__list-item-text-wrapper i{margin-inline-end:8px;color:var(--marker-color)}.elementor-toc__list-item-text-wrapper svg{margin-inline-end:8px;fill:var(--marker-color);height:var(--marker-size,.5em);width:var(--marker-size,.5em)}.elementor-toc__list-item-text-wrapper i{font-size:var(--marker-size,.5em)}.elementor-toc__list-item-text-wrapper:before{font-size:var(--marker-size,1em)}.elementor-toc--content-ellipsis .elementor-toc__list-item-text{white-space:nowrap;overflow:hidden;text-overflow:ellipsis}.elementor-toc__list-items--collapsible>.elementor-toc__list-wrapper>.elementor-toc__list-item>.elementor-toc__list-wrapper{display:none}.elementor-toc__heading-anchor{position:absolute}.elementor-toc__body .elementor-toc__list-item-text{color:var(--item-text-color);-webkit-text-decoration:var(--item-text-decoration);text-decoration:var(--item-text-decoration);transition-duration:var(--item-text-transition-duration)}.elementor-toc__body .elementor-toc__list-item-text:hover{color:var(--item-text-hover-color);-webkit-text-decoration:var(--item-text-hover-decoration);text-decoration:var(--item-text-hover-decoration)}.elementor-toc__body .elementor-toc__list-item-text.elementor-item-active{color:var(--item-text-active-color);-webkit-text-decoration:var(--item-text-active-decoration);text-decoration:var(--item-text-active-decoration)}ol.elementor-toc__list-wrapper{counter-reset:item}ol.elementor-toc__list-wrapper .elementor-toc__list-item{counter-increment:item}ol.elementor-toc__list-wrapper .elementor-toc__list-item-text-wrapper:before{content:counters(item,\".\") \". \"}<\/style>\t\t<div class=\"elementor-toc__header\">\n\t\t\t<h4 class=\"elementor-toc__header-title\">\n\t\t\t\tTable of Contents\t\t\t<\/h4>\n\t\t\t\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--expand\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__6e419942\" aria-expanded=\"true\" aria-label=\"Open table of contents\"><i aria-hidden=\"true\" class=\"fas fa-chevron-down\"><\/i><\/div>\n\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--collapse\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__6e419942\" aria-expanded=\"true\" aria-label=\"Close table of contents\"><i aria-hidden=\"true\" class=\"fas fa-chevron-up\"><\/i><\/div>\n\t\t\t\t\t<\/div>\n\t\t<div id=\"elementor-toc__6e419942\" class=\"elementor-toc__body\">\n\t\t\t<div class=\"elementor-toc__spinner-container\">\n\t\t\t\t<i class=\"elementor-toc__spinner eicon-animation-spin eicon-loading\" aria-hidden=\"true\"><\/i>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t\n\n<div class=\"kk-star-ratings kksr-auto kksr-align-center kksr-valign-bottom\"\n    data-payload='{&quot;align&quot;:&quot;center&quot;,&quot;id&quot;:&quot;12226&quot;,&quot;slug&quot;:&quot;default&quot;,&quot;valign&quot;:&quot;bottom&quot;,&quot;ignore&quot;:&quot;&quot;,&quot;reference&quot;:&quot;auto&quot;,&quot;class&quot;:&quot;&quot;,&quot;count&quot;:&quot;32&quot;,&quot;legendonly&quot;:&quot;&quot;,&quot;readonly&quot;:&quot;&quot;,&quot;score&quot;:&quot;4.7&quot;,&quot;starsonly&quot;:&quot;&quot;,&quot;best&quot;:&quot;5&quot;,&quot;gap&quot;:&quot;5&quot;,&quot;greet&quot;:&quot;*Rate this Medical Aid*&quot;,&quot;legend&quot;:&quot;4.7\\\/5 - (32 votes)&quot;,&quot;size&quot;:&quot;18&quot;,&quot;title&quot;:&quot;How to Report a Medical Aid Scheme for Wrongdoing&quot;,&quot;width&quot;:&quot;105.6&quot;,&quot;_legend&quot;:&quot;{score}\\\/{best} - ({count} {votes})&quot;,&quot;font_factor&quot;:&quot;1.25&quot;}'>\n            \n<div class=\"kksr-stars\">\n    \n<div class=\"kksr-stars-inactive\">\n            <div class=\"kksr-star\" 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<\/div>\n","protected":false},"excerpt":{"rendered":"<p>How to report a medical aid scheme for wrongdoing How to report a medical aid scheme for wrongdoing in South Africa revealed. We verified how to report a medical aid scheme for wrongdoing in South Africa. This is a complete guide to reporting a medical aid scheme for wrongdoing. In this in-depth guide you\u2019ll learn: [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":19858,"parent":161,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_glsr_average":0,"_glsr_ranking":0,"_glsr_reviews":0,"footnotes":""},"categories":[201],"tags":[],"pet-insurance-companies":[],"acf":[],"_links":{"self":[{"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/pages\/12226"}],"collection":[{"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/comments?post=12226"}],"version-history":[{"count":47,"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/pages\/12226\/revisions"}],"predecessor-version":[{"id":35118,"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/pages\/12226\/revisions\/35118"}],"up":[{"embeddable":true,"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/pages\/161"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/media\/19858"}],"wp:attachment":[{"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/media?parent=12226"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/categories?post=12226"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/tags?post=12226"},{"taxonomy":"pet-insurance-companies","embeddable":true,"href":"https:\/\/medicalaid.com\/wp-json\/wp\/v2\/pet-insurance-companies?post=12226"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}