Mark’s role will be to assist members who feel that the Scheme is liable to pay for a certain procedure, or didn’t deal fairly with a provider’s request, etc.Mark will do this by engaging with the Scheme’s medical advisors and clinical departments to fully understand the issues. Taking into consideration prevailing clinical trends, the requirements of the Medical Schemes Act and the intention of the option benefit design. Mark will then deliver a decision as to whether the Scheme should fund a procedure/treatment or if it is not obliged to do so. This process will not take away the member’s right to approach the Council for Medical Schemes (CMS) for assistance. Any recommendations by the Ombudsman are not binding to either party, but serious consideration should be given to them.