The information below summarises the Complaints Process for Hosmed Medical Scheme
Any beneficiary or any person who is aggrieved with the conduct of Hosmed Medical Scheme can submit a complaint. the Scheme and its Administrator undertakes to assist the Complainant to resolve their complaints in a transparent and accessible manner.
STEPS TO FOLLOW
The following steps must be followed to lodge a complaint for any enquiry that was not resolved fully by Hosmed's contact center on 0860 00 00 48 or a query that was submitted to the relevant email address, e.g. firstname.lastname@example.org and email@example.com.
If the complaint is not resolved to the Complainant's satisfaction after calling the call center, a complaint can be emailed to firstname.lastname@example.org for further investigation and resolution.
Please include the contact centre query reference number upon submitting the complaint.
Alternatively, the Complainant can visit the administrator's walk-in centres from Monday to Friday from 08h00 to 17h00.
HOSMED members may also contact
the Administrator's Contact Centre Manager on 011 671 6904 or
the senior manager on (011) 671 4100 with the contact centre query reference number to lodge a complaint.
If the Complainant is still dissatisfied with the outcome of the decision after following step 1 above, the Complainant can request that the matter gets referred to the Dispute Resolution Committee.
If the Complainant is still dissatisfied after the above steps, the matter can be escalated to the Council for Medical Schemes (CMS). Complaints can be submitted by letter, fax and email or in person at the CMS offices on weekdays from 08h00 to 17h00.
For details of the offices, contact numbers and email addresses, please visit http://www.medicalschemes.com. The Council for Medical Schemes governs the medical schemes industry. It facilitates unresolved complaints for members of medical schemes.
The Complainant can appeal to the CMS Registrar's ruling as per Section 49 of the Act which allows any party who is unhappy with the decision of the Registrar to appeal the decision. The appeal is at no cost to either of the parties. An appeal must be lodged within 30 days of the date of the decision.
If the Complainant is dissatisfied with the ruling of the CMS Registrar, an appeal can be lodged with the Appeals Board. Either party has 60 days within which to appeal the decision and must submit written arguments or an explanation of the grounds of his/her appeal.
The prescribed fee of R2,000 is payable for Section 50 appeals.
Issued by Hosmed Medical Scheme on 18 February 2018