Lodge a Complaint

Check Complaint Status

Lodge a Complaint:

Consent

Check this box if you are submitting this complaint on behalf of a member, if not, click next.

Prescription Confirmation

Please confirm that the claim being pursued has not prescribed. In terms of Prescription Act 68 of 1969, claims / debts which have not been pursued for more than 3 years are deemed to have prescribed and can no longer be pursued.

Member Details

I am laying a complaint as*

Entity Member*

Member First Name *

Member Last Name *

Medical Scheme *

Membership Number*

Medical Doctors’ Practice Name*

Member Title *

Member Postal Address*

Member Complex/Building Address

Member Postal Code*

Member Postal Suburb *

Member Postal City*

Member Province *

Member Telephone Number

Member Cell Number*

Member Email Address *

Click next to Continue to the next section.

Complainant/Correspondent Details:

Complainant First Name*

Complainant Last Name *

Complainant Title *

Complainant Postal Address *

Complainant Complex/Building Address

Complainant Suburb *

Complainant City *

Complainant Postal Code *

Complainant Province *

Complainant Telephone Number

Complainant Cell Number *

Complainant Email Address *

Lay Complaint Against:

I hereby lay a complaint against*

Entity Against *

Benefit Option Against *

Complaint Facts

Please provide a summary of the facts of the matter and attach any supporting documentation i.e. accounts, statements, doctor’s reports, broker letters etc. to substantiate your complaint:

Facts of the complaint

Dispute Resolution

Please indicate if you have followed all internal processes complaining against before approaching the Registrar’s Office and if so, please provide details of the process followed.:

Details of dispute resolution processes followed with the Medical Scheme / Administrator / MCO / Broker *

Recourse

Please refer to Complaints procedure to see types of recourse which falls outside the CMS mandate:

What recourse do you require? *

Supporting Documents

Each file should be a maximum of 50MB - You can attach a maximum of 30 files- Accepted file types are 3g2, 3gp, 7z, acc, avi, bmp, csv, doc, docx, dot, f4v, flac, flv, gif, jpeg, jpg, m4a, m4v, mov, mp3, mp4, mpa, mpeg, mpg, msg, odt, ogg, ogv, pdf, png, pps, ppsx, ppt, pptx, rar, rtf, svg, tif, tiff, txt, wav, wma, wmv, xls, xlsx, zip:

Please attach supporting documents

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