online complaint form
BEFORE YOU START COMPLETING THIS FORM:
- Did you complain by sending an email or completing the feedback form that is also available on this page?
- Did you phone our contact centre at 086 0100 678 to ask for assistance?
- Did you visit a customer care counter in your region?
All of the above options are quicker and easier methods for you to get assistance with your query. Please try one of these options before completing this form. If you do however choose to complete this form, please keep in mind that the process to resolve your query might take longer than the suggested processes above.
If you still want to complete the complaint form, please follow these instructions:
- Section A and section B – please complete all the fields, either by writing information, selecting options from drop-down boxes or ticking check boxes.
- Section C – Please give us as much detail as possible about the nature of your complaint, and how the issue/incident unfolded.
- Please be sure to read about your responsibilities and Medihelp’s rights, as well as the notes (section B)
- Please read the points presented in section C carefully before agreeing (by ticking the check box) and submitting your complaint.
Your responsibilities and Medihelp's rights (click here to read more)
By law you have the following responsibilities:
- The responsibility not to submit fraudulent claims.
- The responsibility not to commit fraudulent acts.
A member has the responsibility to:
- Disclose any material information on Medihelp's request and to fill out the medical questionaire on your application form completely and truthfully.
- Pay contributions timeously to Medihelp, i.e. not later than three days after payment is due.
- Give advance notice of termination of membership.
By law Medihelp has the following rights as a medical aid scheme:
- Subject to the Medical Schemes Act, 1998 (Act No 131 of 1998) as amended, Medihelp may restrict the benefits to be granted and limit amounts to be paid to members in respect of particular services.
- The Rules of Medihelp may provide for various interventions designed to promote cost-effectiveness and appropriateness of services, e.g. pre-authorisation.
- Medihelp may refuse to pay a claim that is submitted after the period as prescribed in the Rules.
- Medihelp may restrict interchanges between benefit options to the beginning of a year and require a notice period as set out in the Rules.
On admission to membership Medihelp may impose a:
- 3-month general waiting period; and/or
- 12-month condition-specific waiting period; and/or
- waiting periods on certain PMB conditions.
Please avoid complaints by informing yourself as follows:
- Make sure you know all the provisions of Medihelp's Rules.
- Read all the correspondence from Medihelp, e.g. newsletters and statements.
- Study your benefit guide and familiarise yourself with the coverage offered by the benefit option that you have chosen.
Please tick the applicable box below to confirm whether or not you have familiarised yourself with your responsibilities and Medihelp's rights in terms of the Medical Schemes Act as set out above:
I understand my responsibilities and Medihelp's rights in terms of the Medical Schemes Act. I may not be successful with my complaint if I have not adhered to my responsibilities, or if Medihelp has acted within its rights.
Important links to applicable authorities (click here to read more)
If the complaint is related to any other aspect of the healthcare industry, please contact the following authorities:
- Complaints against health professionals (doctors) - http://www.hpcsa.co.za
- Complaints against private hospitals - http://www.hasa.co.za
- Complaints against nurses - http://www.sanc.co.za
- Complaints against advisers - http://www.faisombud.co.za
- Complaints in respect of other health insurance products - http://www.osti.co.za (short-term insurance ombudsman) or http://www.ombud.co.za (long-term insurance ombudsman)
Details of the aspect about which you are complaining:
Aspect relating to your complaint
Please identify the issue you are complaining about
Is the complaint related to any of your dependants?
When did you first realise there was a problem?
When did you first complain to Medihelp?
Have you instituted legal proceedings in this matter?
Has this complaint been sent to any Ombud?
- If the subject of matter of your complaint is already being pursued by an ombudsman or lawyer, please be advised that Medihelp shall only inform you of the direct feedback given to the ombudsman or lawyer.
- Please ensure that you answer all the questions correctly.
- If you have not completed all the questions fully, Medihelp will unfortunately not be able to assist you with your complaint.
Please tell us what your complaint is about. Remember: We may not know everything about your complaint, so please give as much detail as possible.
Please list in chronological order the phone calls, meetings, or letters you have received or exchanged, and the names of the person(s) to/about whom you were complaining. If you have any documentary proof please attach it.
How would you like your complaint to be resolved? (Outcome expected)
- I would like Medihelp to investigate my complaint.
- I understand that Medihelp or its employees may need to exchange information about my complaint with other organisations (for example to find out important information about my complaint).
- Medihelp will handle complaints in line with relevant legislation and Medihelp's registered Rules.
- Medihelp may refer this matter to an attorney/advocate or relevant ombudsman, but will always respect my privacy and keep my personal information confidential.
- For security and training purposes, Medihelp may monitor or record all phone calls.
Should the outcome of my complaint not be in my/the member's favour, I/the member will be given written reason(s) and will be advised that the complaint may be pursued with the relevant authorities whose contact details will be provided.