A Medical Aid Complaint

relates to the administration of a medical aid scheme, the investment of its funds or the interpretation and application of its rules, and alleging—

(a) that a decision of the medical aid scheme or person taken in terms of the rules in excess of the powers of that medical aid scheme or person, or an improper exercise of its powers;

(b) that the complainant has sustained or may sustain prejudice in consequence of the maladministration of the medical aid scheme by the medical aid scheme or any person, whether by act or omission;

(c) that a dispute of fact or law has arisen in relation to the medical aid scheme between the medical aid scheme or any person and the complainant; or

(d) that an employer who participates in the medical aid scheme has not fulfilled its duties in terms of the rules of the medical aid scheme, but shall not include a complaint which does not relate to a specific complainant.