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Council For Medical Scheme CMS : Submit Complaint Online

Organisation : CMS Council For Medical Scheme
Facility Name : Submit Complaint Online
Applicable For : Any beneficiary (or) Any Person
Country : South Africa
Website : https://www.medicalschemes.co.za/consumer-assistance/complaintsprocedure/

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How To Submit CMS Complaint?

To submit a manual complaint, download the form here and submit it together with your supporting documents to complaints [at] medicalschemes.co.za or post it to:

Related / Similar Facility : CMS Prescribed Minimum Benefit

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The Council for Medical Schemes CMS: Complaints Unit
Private Bag X34

Time Limits For Dealing With Complaints

** Our 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, we ensure that beneficiaries are treated fairly by their medical schemes.
** The Registrar’s Office will send a written acknowledgement of a complaint within 3 working days of its receipt, providing the name, reference number and contact details of the person who will be dealing with a complaint.
** The Registrar’s Office shall within 4 working days of acknowledging the complaint, analyse the complaint and refer to the regulated entity for comments.
** 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 this Act will be referred to the regulated entity for a written response. The entity complained against is obliged to provide a written response to the Registrar’s Office within 30 days.
** Where valid reasons are provided for not meeting the 30 days’ timeframe, the Registrar may grant an extension of deadline.
** Upon receipt of the response, the Registrar’s Office will analyse the response, gather the required evidence and conduct all the necessary investigations to ensure a fair and balanced decision or ruling.
** Decisions/rulings will be issued and communicated to the parties within 120 working days after receipt of all the relevant documentation/evidence
** Where this timeline cannot be met due to complexity of investigations, the Registrar will endeavour to keep complainants updated of developments and reasons for delayed resolution.

Limits To Powers Of The Registrar

The Registrar is may only issue rulings or directives within the scope of the Medical Schemes Act.

The following forms of relief cannot be made by the Registrar:
** Award punitive damages or compensation for delays, pain and suffering;
** Order full refund of contributions, unless provided for in the registered rules of a medical scheme;
** Direct payment of health expenses which are lawfully excluded from benefits in terms of the Act;
** Payment of interest;
** Dismiss or discipline employees of a regulated entity.

Who Can Complain To The Registrar’s Office?

** Any beneficiary or any person who is aggrieved with the conduct of a medical scheme can submit a complaint.
** 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 before approaching the Council for assistance.
** Complaints can be submitted to the CMS by filling in the online form. Click the button below for online submission.

Who Can You Complain About?

The Council for Medical Schemes governs the medical schemes industry and therefore your complaint should be related to your medical scheme.

If your complaint is related to any other aspect of the health industry, please follow the links below:
** For complaints against Health Professionals (doctors) – www.hpcsa.co.za
** For complaints against Private Hospitals – www.hasa.co.za
** For complaints against Nurses – www.sanc.co.za
** For complaints against Brokers – www.faisombud.co.za
** For complaints in respect of other health insurance products – www.osti.co.za (short term insurance ombudsman) or www.ombud.co.za (long term insurance ombudsman)

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