Should you be unhappy with the outcome of your query, this can be escalated to the Fund Manager. E-mail escalations can be sent to [email protected], or the call centre agent can transfer you to their supervisor. All escalations must be accompanied by supporting evidence of non-service delivery.

Any dispute, which may arise between a member, prospective member, former member or a person claiming by virtue of such membership and the scheme or an officer of the scheme, must be referred by the Principal Officer (PO) to a disputes committee appointed by the Board of Trustees, for adjudication.

On receipt of a request in terms of this rule, the PO will convene a meeting of the disputes committee by giving not less than 21 days’ notice in writing to the complainant and all the members of the disputes committee, stating the date, time and venue of the meeting and particulars of the dispute. The disputes committee may determine the procedure to be followed.

The parties to any dispute have the right to be heard at the proceedings, either in person or through a representative. An aggrieved person has the right to appeal to the Council for Medical Schemes (CMS) against the decision of the disputes committee. This appeal must be in the form of an affidavit and directed to Council and shall be furnished to the Registrar not later than three months after the date on which the decision concerned was made.