The Council for Medical Schemes’ latest annual report discloses that no complaints were received in respect of broker-related conduct during the 2024/25 financial year – a notable outcome in an industry where broker accountability and compliance are under constant scrutiny.
The annual report, released last week, outlines key operational and regulatory trends across the medical scheme environment. The report highlights steady progress in customer engagement, complaint resolution, and system upgrades within the regulator’s Member Protection Division.
In a statement accompanying the report, the CMS said the year was marked by “economic volatility, rising unemployment, and ongoing financial pressures on households, which reduced disposable incomes and placed a strain on medical scheme membership”.
Under the leadership of chief executive and registrar Dr Musa Gumede (pictured), the CMS achieved an overall performance score of 96.43%, up from 86% in the previous year. The regulator also received an unqualified audit opinion with no material findings, which it said, “reaffirmed our position as a trusted and transparent regulator with a strong culture of governance, integrity, and accountability”.
The CMS regulates 71 medical schemes (16 open and 55 restricted), serving more than 9.1 million beneficiaries through 33 administrators, 43 managed-care organisations, and more than 10 000 brokers and brokerages.
Call centre: new systems, higher engagement
The Customer Care Centre, part of the Member Protection Division, managed a growing volume of public engagement over the year.
A newly automated call-logging and reporting system was deployed in April 2024, replacing manual tracking processes that had previously limited performance monitoring. The CMS said the system provides “a baseline for future performance tracking” and could later be extended to other units within the organisation.
Between 1 April 2024 and 31 March 2025, the Centre handled:
- 27 896 inbound telephone calls, including dropped or lost calls;
- 10 860 emails, of which 5 776 were valid service queries; and
- 90 in-person walk-in consultations.
Broker-related engagement accounted for a substantial share of contact volumes, with 10 965 queries (about 46%) relating to broker accreditation, certification, and portal access. The CMS said many of these were resolved at first contact, improving turnaround times.
Other frequent query types included:
- 4 011 general medical scheme queries (17%);
- 2 771 statutory interpretation requests (11%) involving the Medical Schemes Act (MSA);
- 4 158 benefit-related queries (13%); and
- 3 095 complaint-related contacts (13%).
The CMS said its service channels continue to evolve, with plans to integrate WhatsApp-based access for frequently asked questions to improve convenience and accessibility.
Complaints continue downward trend
The total number of registered complaints declined again in 2024/25, continuing a three-year downward trajectory.
A total of 1 962 new complaints were lodged during the year, 99% of which were against medical schemes. Of these, 1 459 (75%) related to open schemes and 478 (25%) to restricted schemes.
Complaints against other regulated entities remained minimal and mostly declined:
- Complaints against administrators dropped from 20 to seven (a 65% decrease).
- Complaints against managed-care organisations fell from three to one.
- Complaints against exempted insurers offering demarcation health products increased from 10 to 17.
No complaints were received in respect of broker conduct.
The CMS resolved 1 879 complaints during the reporting period – 1 740 justiciable and 139 non-justiciable – with more than 80% finalised within the prescribed timeframes. The regulator said it continues to work to reduce the number of cases exceeding standard resolution timelines.
A focus on transparency and member protection
The CMS said its complaint and call centre activities are central to its mandate under section 7 of the MSA, which requires the protection of members’ interests and the promotion of fair and transparent practices in the sector.
“We wish to assure all stakeholders – including members, healthcare providers, and industry partners – of our unwavering commitment to regulatory oversight, stability, and the continued protection of beneficiaries,” said Gumede.
