1. OVERALL PURPOSE

The purpose of the Complaints Policy is to provide guidance to members, prospective members and former members, on the process of lodging a complaint and resolving such complaint, or dispute, in accordance with Rule 29 of the Scheme Rules.

2. OVERVIEW AND PROCESS

Members may lodge their complaints telephonically, or in writing, to CompCare via Universal Healthcare Administrators on 0861 222 777 or e-mail address [email protected]. The Escalations team will assist the member immediately where possible. All complaints received will be responded to by the Universal Healthcare Escalations team, in writing, within 30 days of receipt thereof and copy the Fund Manager on the response.

The complainant will be provided with a right to reply, or he/she may request a mediation meeting to be held at the Scheme’s offices or virtually to try and resolve the matter.

In the event that the matter is not resolved, a dispute will automatically be declared and must be referred to the Principal Officer for a formal outcome which will be communicated to the complainant in writing.

The parties to any dispute have the right to make written representation themselves, or through a representative.

An aggrieved person has the right to appeal to the Council for Medical Schemes against the decision of the Principal Officer. Such appeal must be in the form of an affidavit and directed to the Council for Medical Schemes not later than three months after the date on which the decision concerned was made.

The operation of any decision which is the subject of an appeal under rule 29.6 shall be suspended pending the decision of the Council on such appeal.

The contact details of the Council for Medical Schemes: 086 112 326 and e-mail: [email protected].

Signed at Roodepoort on 28 February 2025.