2024 ESSENTIAL PLUS & ESSENTIAL NETWORK
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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 in writing to the
scheme. 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 can 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
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