Unhappy about service from the Scheme?
We understand that members expect reliable and efficient service from the Scheme at all times. To help you resolve any medical scheme issues you may have, or if you have a complaint about service you received, please follow the process below:
- Contact the Medscheme Call Centre on 0860 100 080 or via e-mail on firstname.lastname@example.org and provide the details of your complaint. The advantage of going through the Call Centre is that calls are recorded and trends can be picked up, allowing the Scheme to identify specific communication needs.
- If you are not satisfied with the outcome, make use of the following process to ensure effective and accurate resolution of your query:
LEVEL 1: Call the Scheme and request the assistance of an Escalation Consultant.
LEVEL 2: If thereafter you are still not satisfied, email our Member Feedback department on email@example.com.
LEVEL 3: If thereafter you are still not satisfied, contact the Fund Manager (Hope Modise on +27 11 758 8580).
LEVEL 4: If thereafter you are still not satisfied, contact the Assistant Principal Officer (Felicia Oortman on +27 10 234 5595).
LEVEL 5: If thereafter you are still not satisfied, contact the Principal Officer (Julia le Roux on +27 10 227 2854).
- If, after following the procedure detailed above, you are still not satisfied with the outcome of the process, or you have not received a response within seven (7) working days, you may in terms of the Scheme Rules request the Principal Officer to have your dispute settled via a dispute committee. This committee will consist of three members who are not members of the Board, any other officer of the Scheme or a Medscheme employee, and will be appointed by the Principal Officer. The Principal Officer will give at least 14 days’ notice of the meeting to take place, and a member may either attend in person, or via a representative. This process is described in more detail in Rule 31, which you may request from the Scheme.
- If you feel that the dispute committee did not resolve your issue, you may appeal to the Council for Medical Schemes (CMS). (This process is also described in Rule 31.) These are the contact details for the Complaints Department at CMS: