South Africa National Health Insurance Act 20 of 2023 42: Complaints: lodge, investigate within 30 days, and give providers notice and representations before adverse decisions

What does 42 require?

A user, provider, establishment or supplier may lodge a complaint with the Fund under procedures the Fund sets with the Minister, and the Fund has to handle it promptly and lawfully; the Investigating Unit must investigate and recommend a resolution to the Chief Executive Officer within 30 days of receipt, and the complainant receives written notice of the outcome and any decision within a reasonable time (section 42(1) to (3)). Before a decision to withdraw or refuse renewal of a provider's accreditation takes effect, the Fund must give the provider notice, a reasonable opportunity to make representations, consider them and give adequate reasons (section 42(4)). An aggrieved party may appeal to the Appeal Tribunal within 60 days of written notice of the decision (section 43).