CAMAF Member Option Guides & Info

2021 Vital [Brochure]

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32 VITAL 2021 What do I do if I have a dispute with the scheme? Queries are dealt with by the Customer Care Department. If satisfaction is not received, there is an escalation process to be followed within the scheme. Members may lodge their complaint/s in writing. You can expect a written reply within 30 days of receipt of your complaint / dispute. If satisfaction is not obtained as a result of the normal escalation process, it will be referred by the Principal Officer to the Disputes Committee, which is appointed by the Board. A meeting will be convened by giving not less than 21 days' notice in writing to the scheme member and the disputes committee giving the date, time, place and details of the dispute. A member has the right to be heard at these proceedings either in person or through a representative. What do I do if I am not satisfied with the service or decisions made by CAMAF? There is a complaints procedure to be followed within the scheme - consult the website. If you have followed this complaints procedure and you still feel aggrieved, you wish to appeal the outcome of a dispute (see above), or believe that the scheme has not: • made an acceptable clinical decision, • applied the scheme rules correctly, • contravened the Medical Schemes Act, you may contact the Council for Medical Schemes in writing giving full details of your case and the reasons for your complaint. For a complaint form and contact details go to www.medicalschemes.co.za or send an email to complaints@ medicalschemes.co.za. The Council can be contacted telephonically on 012 431 0500 or 086 112 3267. COMPLAINTS & DISPUTES 32

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