The medical aid ombudsman is a body that one can approach for recourse concerning a number of different issues that relate to your medical aid scheme or service provider, or any other issue related to your medical aid. This can also include the end service providers who are contracted through that particular medical aid or who are a pert of that medical aid scheme.
Another way that one can look at the medical aid ombudsman is as a sort of big brother that is there to look after your interests as far as ensuring that all issues that relate to your medical aid scheme can be addressed and that all actions are above board, legal and ethical. In the past there was no specific medical ombudsman in the same way that there were other ombudsmen in place to address other issues such as government corruption or the misuse or abuse of power and so on. The medical aid scheme council of South Africa more or less acts as a collective ombudsman in this regard, however this is also known as the council for medical schemes and this is basically how it works.
The council for medical schemes is the governing body of all of South Africa’s medical aid schemes and service providers, it is an extremely important body because it basically has to oversee and regulate around ninety seven or so medical aid scheme service providers operating in South Africa, collectively eight million four hundred plus beneficiaries and this entire industry is worth over eight five billion Rand, so as one can clearly see it is an enormous industry indeed. With such a huge industry there is a very clear need to have an all encompassing regulatory body in pace to ensure that all is above board and that beneficiaries have legal recourse in the form of the council for medical schemes.
The council for medical schemes is actually a very important body and is appointed by government, the legal act behind this appointment is in fact the medical schemes act number one thirty one of nineteen ninety eight and the governing board is actually appointed by the minister of health. This is really as close to a medical aid ombudsman that you can get and is in fact a very effective and well organized body.
Now you may be wondering how exactly this council for medical schemes can benefit you and the answer is actually really quite simple. The way that the council is set up is that anyone that has any kind of a complaint to do with their medical aid scheme can approach the council for recourse. There is no limitation or stipulation as to the kind of problems that someone can complain about or seek recourse over, basically any problem that you may have so if you are feeling aggrieved by you medical aid service provider then you can approach the council.