Steps to escalate your query: Complaints and appeals process
If you are not satisfied with how we processed your claims or if you want to lodge a complaint, you can follow this process:
- Contact the Fund's client service department on 0800 00 16 15 during office hours or send an email to service@engenmed.co.za to resolve your query.
- If you are not satisfied with the result, you can ask that more senior resources in the administrator's service team, such as a team leader or manager, look into the case. You can send the query to escalations@engenmed.co.za
- If you are not satisfied with the outcome of the escalation process, you can ask the Principal Officer of the Fund to deal with the matter. You must write to service@engenmed.co.za and address your query or complaint to the Principal Officer.
Once you have followed these steps, and are still not satisfied with the outcomes, you may declare a dispute
If you do not accept the outcome of the escalation process to the Principal Officer, you can lodge a complaint in writing, for the attention of the Fund's Disputes Committee. Send your complaint to the Committee at service@engenmed.co.za c/o the Principal Officer. The Principal Officer will follow the process to set up a formal meeting of the Disputes Committee to decide on your complaint or dispute. You have the right to be heard at these proceedings, either in person or through a representative. Read more about the Disputes process .
The Council for Medical Schemes is your last resort
If you are still not satisfied after the Disputes Committee's decision, you can approach the Council for Medical Schemes for resolution. Please include query reference details provided by the Fund administrator and/or a copy of the Disputes Committee's decision when you write to the Council:
Address: Block A Eco Glades 2 Office Park, 420 Witch-Hazel Street, Ecopark, Centurion 0157
Telephone: 012 431 0500
Fax: 012 431 7544
Customer care call number: 0861 12 32 67
Email address: complaints@medicalschemes.co.za