Council for Medical Schemes
There are many financial services available in South Africa. Therefore, it is important that they be governed by an outside entity. And for medical aid schemes this is no different. So this is where the Council for Medical Schemes enters the picture.
What is the council for medical schemes?
• Importantly, the council is a regulatory board established by the Medical Schemes Act to regulate the medical aid schemes in South Africa.
• The Minister of Health employs the managing board of the council.
• Significantly, the council supervises over 96 schemes with more than 8 million members.
10 reasons why the council is important to you as a member of a medical scheme
- They protect the interests of medical aids and their members.
- The council also monitors the financial soundness and solvency of the schemes. Importantly, this monitoring ensures that your scheme will have enough money available to pay the claims of their members.
- In addition, they co-ordinate and control the functioning of the schemes with regard to the national health policy.
- The council settles disputes and investigates claims.
- They study information regarding the private health care in South Africa. This means the monitoring of both the costs of private healthcare and the quality of care you receive.
- The council makes recommendations to the Minister of Health regarding quality control and services offered by the schemes.
- They ensure that the rules of the medical schemes are fair in relation to the Medical Schemes Act. The schemes will not be permitted to impose rules on their members of which the council does not approve.
- The council manages accreditation of both brokers and schemes. This means that the schemes and the brokers have to be part of the council and are thus managed according to the Medical Schemes Act.
- They ensure that the schemes and brokers comply with the Medical Schemes Act.
- The council pre-approves all benefit plans the schemes provide, to ensure that you have the best medical aid options available.
What can the Council for Medical Schemes do for you?
The council acts like the medical ombudsman in the event of claims disputes that need resolving.
You are free to contact the council regarding any problems you have with your medical aid. They will investigate the problems and come up with a solution.
The council ensures that you receive affordable medical aid and the best medical care available.
How do you reach the council?
Telephone: 0861 123 267
Postal Address: Private Bag X34
Physical Address: Block A
Eco Glades 2 Office Park
420 Witch – Hazel Avenue
The Council of Medical Schemes provides a valuable service to both the schemes and their members. They ensure that you are charged reasonable premiums and receive your money’s worth. They will also settle any disputes that you might have with your scheme.