What kind of disputes may be referred to the Bestmed Dispute Committee?
The Bestmed Disputes Committee is only empowered to hear disputes arising from the membership status of a member which may include, but are not limited to, disputes concerning:
The Bestmed Disputes Committee may not hear any complaints relating to the conduct of employees of the scheme.
Who may refer a dispute to the Bestmed Dispute Committee?
The following categories of people may lodge disputes with the Bestmed Dispute Committee and shall be referred to thereafter as the “Complainant”:
Steps to follow in lodging a complaint/dispute:
Process to be followed before a dispute can be referred to the Bestmed Dispute Committee:
Process to refer a matter to the Bestmed Dispute Committee:
What forms must be completed in lodging a dispute?
What happens to the form once it has been sent?
Following receipt of the completed form and subject to any other requirements communicated to the member being satisfied, the CEO/Principal Officer will convene a meeting with the Bestmed Dispute Committee, as soon as reasonably possible. Notice of the meeting shall be given within no less than 21 (twenty-one) days prior notice, stating the date, time and venue of the meeting, and the particulars of the dispute.
Process after the CEO/Principal Officer has sent notice of the meeting to a Complainant and the Bestmed Dispute Committee
The Chairperson of the Bestmed Dispute Committee will, within seven (7) days of receiving the notice of the meeting and documents, inform the CEO/Principal Officer or Secretariat of the following:
Additional considerations for scheduling disputes.
In consideration of the dispute lodged, the Committee may decide to either adjudicate the matter on papers or request oral evidence. In cases where the Committee decides to adjudicate the matter on the papers, the committee has the authority to request further particulars from the Complainant or from Bestmed.
In arriving at its decision, the Committee will afford both parties the right to be heard in the proceedings.
The complainant who wishes to have legal representation must inform the committee within ten (10) days of the sitting that he/she wishes to be represented during the proceedings.
The committee has the right to decide whether to allow such representation or not. Should this be allowed, the complainant making use of the services of a legal representative shall bear the costs of such legal representation.
How will the Bestmed Dispute Committee adjudicate a dispute?
The Bestmed Dispute Committee shall, in writing, communicate the decision of the committee to the complainant and to the Bestmed Principal Officer within thirty (30) days after the meeting.
The decision of the Bestmed Dispute Committee is binding on the Complainant and Bestmed; however, should a Complainant be dissatisfied, the said party may appeal against said decision to the Council for Medical Schemes in terms of Section 48 of the Medical Schemes Act.
The Bestmed Dispute Committee’s decision will be suspended pending the decision of Council for Medical Schemes.
Disputes referred to the CMS:
The Council for Medical Schemes encourages a prospective complainant to first exhaust the complaints mechanisms in place at his/her medical scheme. However, should the Scheme come to knowledge that a Complainant referred a dispute simultaneously to both the Council for Medical Schemes and the Bestmed Dispute Committee, the Scheme shall cease with its internal complaints mechanism and follow the route of resolving the complaint through the Council for Medical Schemes.
In the event of a conflict between this guide and the Bestmed Rules approved by the Board of Trustees, the Bestmed Rules will prevail and will be applied.
FORM A: Bestmed Dispute Referral Form.