Know your rights concerning medical aid schemes

If you work hard for your money, you shouldn’t have to bargain for something you pay for. People often feel cheated by their medical aid companies when expectations aren’t met. This can be because people are uninformed about their scheme and its benefits or it can be because a company is indeed acting unethically. Once properly informed, you will know whether you should search for a new medical aid scheme or if you should just carry on paying your monthly contribution.

This is why the Council for Medical Schemes (CMS) exists. CMS’s vision reads “to promote vibrant and affordable healthcare cover for all” and this is what they want to achieve as outlined by their various goals.  The council has the responsibility to protect both you and the medical aid companies, and they strive to do so fairly and transparently.

Where can I learn my rights?

The council hosts various workshops, programmes and other initiatives surrounding consumer awareness and education. You can simply email the council’s spokesperson to receive news concerning upcoming events that will inform you about your rights as a consumer. The CMS describes sessions as detailed presentations about:

•         the role of CMS
•         member rights
•         complaints procedures
•      prescribed minimum benefits (PMBs)

Also be sure to visit the CMS website to read about what they do, find answers to frequently asked questions, get consumer assistance and access a public and governmental entities directory.

How can I submit a complaint?

You must contact your medical aid company first. You can send them an email or you can phone them: companies are required to have call centres to handle complaints and queries. They are also obligated to have mechanisms in place to handle consumer disputes. If you are still dissatisfied with your medical aid, you can lodge a formal complaint at the Council for Medical Schemes Complaint Unit.