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Promotion of Access to Information Manual

Prepared in terms of section 51 of the Promotion of Access to Information Act, 2 of 2000, read with the Protection of Personal Information Act, 4 of 2013

1. Introduction

Momentum Medical Scheme (“the Scheme”) is a medical scheme registered in terms of the Medical Schemes Act 131 of 1998 (Registration Number 1167). It is an open medical scheme providing benefits to members in terms of the registered rules of the Scheme.

The Promotion of Access to Information Act 2 of 2000 (“PAIA”) gives effect to the constitutional right of access to any information held by public (government) or private (non-government) bodies that is required for the exercise of protection of any rights and to provide for matters connected therewith.

Where a request is made in terms of PAIA, the Scheme will give access to any record, provided that the record is required for the exercise or protection of any rights, the requestor complies with the requirements of PAIA relating to a request for access to the record and access to the record is not refused in terms of any ground for refusal contemplated in Chapter 4 of Part 3 of PAIA.

The Scheme is a private body as defined in PAIA and this manual is therefore prepared in terms of section 51 of PAIA and informs the requestor of procedural and other requirements which a request must meet.

PAIA recognises certain limitations to the right of access to records, which is contained in this manual.

This manual will be updated on a regular basis in accordance with section 51(2) of PAIA.

2. Contact details

Scheme Details for Access to General Records:

Postal Address

PO Box 2338
Durban
4000

Physical Address

201 uMhlanga
Ridge Boulevard
Cornubia
Durban
4339

Phone No

0860 117 859

Email Address

member@momentumhealth.co.za

Website

https://momentummedicalscheme.co.za/

Contact details of Momentum Medical Scheme’s Information Officer:


Name

Toni van den Bergh

Designation

Chief Executive and Principal Officer

Phone No

073 708 9219

Email Address

compliance@momentumhealth.org

Contact details of Momentum Medical Scheme’s Deputy Information Officer:


Name

Lenny Mariemuthu

Designation

Scheme Executive: Operations

Phone No

031 573 4236

Email Address

compliance@momentumhealth.org

3. Access to records automatically available

The following records are automatically available to Members of the Scheme in terms of the Medical Schemes Act 131 of 1998 and need not be requested in accordance with the procedure outlined in section 5 of this manual:

  • Scheme Rules and all Annexures thereto
  • Audited Annual Financial Statements
  • Notices of Annual General Meetings and other general meetings if applicable
  • Minutes of Annual General and Special General meetings

The following records are automatically available to the Beneficiaries of the Scheme and need not be requested in accordance with the procedure outlined in section 5 of this manual:

  • Their own claim information
  • A Member is entitled to their minor beneficiary’s claims information
  • Their own membership information
  • Scheme brochures and member communications

The following records are automatically available to the potential members of the Scheme and need not be requested in accordance with the procedure outlined in section 5 of this manual:

  • Scheme brochures
  • Other marketing information

The following records are automatically available to the accredited brokers who are authorised by the Scheme to market the Scheme, solicit enrolment of prospective members of the Scheme and to render ongoing services to existing members and need not be requested in accordance with the procedure outlined in section 5 of this manual:

  • Their existing Member’s and Beneficiary membership details
  • Their existing Member’s billing statements
  • Scheme brochures and general Member communications
  • Their commission statements
4. Access to records not automatically available

This section of the manual sets out the subject and category of records held by the Scheme that are not automatically available without request in terms of PAIA and for which certain grounds of refusal as set out in PAIA may be applicable.

  1. Financial

    • Quarterly Statutory Returns
    • Executive Summaries
    • Budgets and Forecasts
    • Member Debt Schedules
    • All documentation generated/received in the raising and collection of contributions
    • All documentation generated/received in connection with the payment of broker commissions
    • Ledgers and Journals
    • Investment reports and details
    • Other Member’s accounts, statements, and all other records of claims
    • Reconciliations
    • Auditor’s Management letters
    • Scheme bank account statements, and all other records relating to the Scheme’s bank accounts
    • All invoices, and other records received from third parties.
    • Management accounts and unaudited Annual Financial Statements
    • Asset register
    • Records regarding insurance held by the Scheme
  2. Contracts

    • Administration Agreements
    • Managed Healthcare Agreements
    • IT agreement
    • Professional Indemnity Insurance
    • Agreements with Providers
    • Agreements with Brokers
    • Agreements with Investment Managers
    • Employment and consulting agreements
    • All other agreements entered into with third parties
    • All correspondence and other records relating to the above-mentioned agreements.
  3. General

    • All communication to members, providers, brokers and other third parties
    • Employer group details
    • Application forms and member records
    • Membership profiles
    • Broker profiles
    • Claiming profiles
    • Medical reports
  4. Scheme Records

    • Records relating to the registration of the Scheme as a medical scheme
    • Trustees’ personal details
    • Records of the appointment and election of Trustees and Independent Committee Members
    • Trustee and Independent Committee Members remuneration record
    • Attendance registers
    • Minutes of the Board of Trustees meetings
    • Board of Trustees meeting packs
    • Minutes of Board Committee meetings
    • Board Committee meeting packs
    • Minutes and packs of Audit Committee meetings
    • Ex-Gratia applications and all supporting documentation
    • All documentation in respect of the Trustee election process
    • Board resolutions
    • Management reports
    • Policies and procedures
  5. Employee Records

    • List of employees
    • Appointment records
    • Payroll records
    • Health and safety records
    • Codes of conduct and undertakings of confidentiality
    • Internal policies and administrative forms
    • Training schedules
    • PAYE records
    • Personnel records

5. Procedure for requesting information

Records of, or held by, the Scheme will be accessed only once the prerequisite requirements for access have been met by a requestor and once access is granted. A requestor is any person making a request for access to a record of, or held by, the Scheme. There are two types of requestors:

  • Personal requestor, who is a requestor seeking access to a record containing personal information about the requestor. The Scheme will voluntarily provide the requested information or give access to any record regarding the personal requestor’s personal information. The prescribed fee for reproduction of the information requested will be charged.
  • Other requestor, who is a requestor entitled to request access to information on third parties. However, the Scheme is not obliged to voluntarily grant access. The requestor must fulfil the necessary requirements for access in terms of PAIA, including the payment of a request and access fee.
  • All personal information requests shall be determined by the considerations in the Protection of Personal Information Act 4 of 2013 and PAIA as well as the Regulations and Guidelines issued thereunder.
  • A request must be made on the prescribed Form, available on the website of the Information Regulator or by following this link https://www.justice.gov.za/inforeg/docs/forms/InfoRegSA-PAIA-Form02-Reg7.pdf
  • The completed prescribed Form must be submitted to the Request/Compliance Officer at the postal address or physical address, fax number or electronic email address recorded in paragraph 2 above, and pay a request fee and a deposit, where so advised.
  • The requestor must provide sufficient detail on the prescribed Form C to enable the Request/Compliance Officer to identify the record or records requested and the identity number of the requestor.
  • If the request is made on behalf of another person, then the requestor must submit proof of the capacity in which the requestor is making the request to the reasonable satisfaction of the Request/Compliance Officer.
  • In addition, the Requestor must identify the right the requestor is seeking to exercise or protect and provide an explanation of why the requested record is required for the exercise or protection of that right.
  • The Scheme may and in certain instances must, refuse access to records on any of the grounds as set out in Chapter 4 of Part 3 of PAIA which includes that access would result in the unreasonable disclosure of personal information of a third party.
  • If an individual is unable to complete the prescribed Form because of illiteracy or disability such a person may make the request orally to the Request/Compliance Officer.
6. Decision

The Scheme is obliged to inform the requestor in writing of its decision. If the requestor wishes to be informed in any other manner, the requestor must state that manner and provide the necessary particulars to be so informed.

The Request/Compliance Officer will make a decision within thirty (30) days after the request has been received.

The 30-day period within which the Scheme must decide whether to grant or refuse the request, may be extended for a further period of not more than 30 days, as provided for in PAIA. If a period is extended, the Request/Compliance Officer must notify the requestor of:

  • The period of the extension
  • Adequate reasons for the extension, including the provisions of PAIA relied upon
  • That the requestor may lodge a complaint with the Information Regulator or an application with a court against the extension, and the procedure (including the period) for lodging the complaint with the Information Regulator or the application.
  • If the request is granted, the Request/Compliance Officer shall advise the requestor of the access fee (if any) to be paid upon access, the form in which access will be given, and that the requestor may lodge a complaint to the Information Regulator or an application with a court against the access fee to be paid or the form of access granted, and the procedure, including the period allowed, for lodging a complaint to the Information Regulator or the application.

If the request for access is denied, the Request/Compliance Officer shall advise the requester in writing in a notice of refusal. The notice of refusal shall state:

  • Adequate reasons for the refusal including the provisions of PAIA relied on
  • Exclude, from any such reasons, any reference to the content of the record
  • That the requester may lodge a complaint to the Information Regulator or an application with a court against the refusal of the request and the procedure (including the period) for lodging a complaint to the Information Regulator or the application.

If the Request/Compliance Officer fails to respond within thirty (30) days after a request has been received, or within any extended time period, it is deemed, in terms of Section 58 read together with Section 56(1) of PAIA, that the Request/Compliance Officer has refused the request.

7. Grounds for refusal

The Scheme may refuse a request for information based on the following grounds:

  • Mandatory protection of the privacy of a third party who is a natural person.
  • Mandatory protection of the commercial information of a third party.
  • Mandatory protection of certain confidential information of a third party.
  • Mandatory protection of the safety of individuals and the protection of property.
  • Mandatory protection of records which would be regarded as privileged in legal proceedings or correspondence as between attorney and client.
  • The commercial information of the Scheme.
  • Research information of the Scheme or a third party.
8. Remedies available regading an Act of failure to Act

A requester or a third party, who is dissatisfied with the Information Officer’s refusal to disclose information or the disclosed information, may follow the remedies available in law regarding an act or failure to act in respect of a right or duty conferred or imposed by PAIA and POPIA, by following these steps:

  • Lodge an internal appeal at complaints@momentumhealth.org ;
  • Lodge a complaint with the Information Regulator at PAIAComplaints@inforegulator.or.za ;
  • Lodge an application with a court against a decision by the Information Officer, a decision on internal appeal or a decision by the Information Regulator.
9. Records not found

If a requested record cannot be found or if the records do not exist, the Request/Compliance Officer must, by way of an affidavit notify the requester that it is not possible to give access to the requested record.

The affidavit must provide a full account of all the steps taken to find the record or to determine the existence thereof, including details of all communications by the Request/Compliance Officer with every person who conducted the search.

This notice will be regarded as a decision to refuse a request for access to the record concerned for the purposes of PAIA.

Should the record be found later, the requester must be given access to the record in the manner stipulated by the requester in the prescribed Form C unless access is refused by the Request/Compliance Officer.

10. Request for information of a third party

Section 71 of PAIA makes provision for a request for information or records about a third party.

In considering such a request, the Scheme will adhere to the provisions of Section 71 to 74 of PAIA.

The attention of the requester is drawn to the provisions of Chapter 5 Part 3 of PAIA in terms of which the Scheme is obliged, in certain circumstances, to advise third parties of requests lodged in respect of information applicable to or concerning such third parties. In addition, the provisions of Chapter 2 of Part 4 of PAIA entitle third parties to dispute the decisions of the Request/Compliance Officer by referring matters to a court of law.

11. Fees

PAIA provides for two types of fees, namely:

  • A request fee, which will be a standard fee; and
  • An access fee which will be calculated by taking into account reproduction costs, search and preparation time and cost, as well as postal costs, if applicable.

When the request is received by the Request/Compliance Officer, the Request/Compliance Officer must by notice require the requestor to pay the prescribed request fee (if any) before further processing of the request.

If the preparation of the record requested requires more than the prescribed hours determined by the Scheme’s Request/Compliance Officer, a deposit shall be paid (of not more than one third of the access fee which would be payable if the request were granted).

A requester may lodge an application with a court against the tender/payment of the request fee and/or deposit.

The Request/Compliance Officer can withhold a record until the requestor has paid the fees as indicated.

A requestor whose request for access to a record has been granted, must pay an access fee for reproduction, for search, preparation and for any time reasonably required in excess of the prescribed hours to search for and prepare the record(s) for disclosure including making arrangements to make it available in the requested format.

Upon the refusal by the Request/Compliance Officer, any deposit paid by the requester will be refunded.

The request fee payable by a requester, other than a personal requester, referred to in regulation 11(2) of PAIA is R50.00.

To search for and prepare the record for disclosure, R30.00 for each hour or part of an hour reasonably required for such search and preparation. If the Request/Compliance Officer is of the opinion that six hours will be exceeded to search, prepare and/or reproduce the record, the Request/Compliance Officer can request a deposit, equal to one-third of the access fee payable, to be paid by the requester.

The actual postage is payable when a copy of a record must be posted to a requester.

The fee for a copy of the manual as contemplated in regulation 9 (2) (c) is R1,10 for every photocopy of an A4-size page or part thereof.

The fees for reproduction are as follows:


Description

R

For every photocopy of an A4-size page or part thereof

1.10

For every printed copy of an A4-size page or part thereof held on a computer or in electronic or machine-readable form

0.75

For a copy in a computer-readable form on:
a) flash drive, memory stick
b) compact disc

7.50
70.00

For a transcription of visual images, for an A4-size page or part thereof

40.00

For a copy of visual images

60.00

For a transcription of an audio record, for an A4-size page or part thereof

20.00

For a copy of an audio record

30.00

12. Protection of personal information

The purpose for which the Scheme processes Personal Information includes but is not limited to:

  • Providing and managing any information, products and/or services requested by members and non-members
  • Providing health services to members
  • Administering claims and member premiums
  • Transacting with service providers, managed facilities, hospitals, pharmacies, and health practitioners
  • Maintaining member records
  • Maintaining service provider records
  • Maintaining broker records
  • General administration, financial and tax purposes
  • Legal and/or contractual purposes
  • Compliance with legal and regulatory requirements
  • Health and safety purposes
  • Wellness information
  • Recovery of debts

Categories of Data Subjects and their Personal Information:


Data Subject Category

Personal Information Processed

Natural persons (members, potential members, employees)

Race, gender, sex, pregnancy, marital status, nationality, age, physical and mental health, well-being, disability, language, birth, medical history, contact details, physical and postal addresses, email address, identity and passport numbers, dependents, confidential information, employment, and financial information

Juristic persons (service providers, suppliers, managed healthcare facilities, brokers)

Contact details, physical and postal addresses, email address, registration number, confidential information, tax and financial information, FICA documents

Categories of Recipients for Processing the Personal Information The Scheme may supply the Personal Information to:

  • Scheme personnel
  • Trustees, Committee members and Members
  • Scheme brokers
  • Relevant healthcare service providers including managed healthcare facilities, hospitals, pharmacies, and health practitioners
  • Regulatory authorities
  • Approved service providers, contractors and suppliers appointed by the Scheme

Actual or Planned Trans-Border Flows of Personal Information

  • The Scheme may from time to time disclose Personal Information to service providers outside of South Africa, for the purposes of rendering services to its members, including cloud services hosted in international jurisdictions, and will only do so in accordance with South African legislative requirements or if the relevant data subject consents to such transfer.
  • Where Personal Information is transferred outside South Africa, the Scheme will take steps to ensure that such transfer is subject to laws, binding corporate rules or binding agreements that provide for similar or better levels of protection and lawful processing of Personal Information.

General Description of Information Security Measures

  • The Scheme maintains reasonable technical and organisational measures to protect Personal Information processed by the Scheme, including policies, procedures and controls aimed at preventing any unauthorised access to, loss or destruction of Personal Information.
  • The Scheme has a wide range of security measures designed to mitigate data security breaches, accidental loss, or destruction of, or damage to, Personal Information, which include, but is not limited to:
    • Secure access control
    • Secure and actively managed hardware devices and software on the network
    • Continuous vulnerability management
    • Email and web browser protections
    • Malware and boundary defences
    • Management of network ports, protocols, and services
13. Guide on how to use PAIA

The Regulator has, in terms of Section 10(1) of PAIA, as amended, updated, and made available a Guide, in an easily comprehensible form and manner, as may reasonably be required by a person who wishes to exercise any right contemplated in PAIA and POPIA.

The Guide is available in each of the official languages, and in braille.

Members of the public can inspect or make copies of the Guide from the offices of the Information Regulator, during normal working hours at:
JD House
27 Stiemens Street
Braamfontein
Johannesburg, 2001.

The Guide is also available:

  • in all official languages from the website of the Information Regulator at https://www.justice.gov.za/inforeg/docs.html
  • by accessing it directly by following one of these links:
    • for an English version:
      https://www.justice.gov.za/inforeg/docs/misc/PAIA-Guide-English_20210905.pdf
    • for an Afrikaans version:
      https://www.justice.gov.za/inforeg/docs/misc/PAIA-Guide-Afrikaans_20210905.pdf
    • for an isiXhosa version:
      https://www.justice.gov.za/inforeg/docs/misc/PAIA-Guide-Xhosa_20210914.pdf
    • for an isiZulu version:
      https://www.justice.gov.za/inforeg/docs/misc/PAIA-Guide-isiZulu_20210905.pdf
  • at the Scheme’s offices, during normal working hours.
14. Availability of the manual

This manual is available for inspection on the Scheme’s website, alternatively, a copy may be requested from the Deputy Information Officer at the address of the Scheme in paragraph 2.3 above.