JT
Jacques T
1 reviews | Active since Feb 2024
15 Feb 2024, 13:45
********* Business Practise
Been with Ambledown for many many years and religiously paid my subs every month without fail. Got retrenched in 2020 and changed from medical aid to medical insurance. I havent had any claim with Ambledown since going on to medical insurance in December 2021. In January my son needed CT scans, medical insurance covered 2/3 and I figured I would claim the balance from my Ambledown GAP cover. Surprise Surprise when I'm told I dont have cover under medical insurance, I'd ONLY have cover under a medical aid. Nobody advised me that Ambledown's cover wont be valid under medical insurance. So I accept this and request refund of my premiums paid from December 2021 to February 2024 (a total of R8120). I'm then advised they can only refund me from September 2022 to date because they changed underwriters and the previous underwriters are in liquidation. Problem is that my debit order runs from AMBLEDOWN, my money gets deducted and paid into AMBLEDOWN's bank account. Who they contract with is not my problem. They went ahead and refunded me R5588. Where's the rest of my money AMBLEDOWN?????
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Ambledown's replyOfficial
22 Mar 2024, 08:18Dear Jacques T,
Thank you for the review and kindly excuse the long response.
1. As at December 2021 when you changed products from a medical aid product to medical insurance, the role players to your insurance contract were· Insurer – Constantia Insurance Company Limited, your insurer (the risk carrier with whom your policy is placed) · Intermediary – NMG Consultants And Actuaries (Proprietary) Limited, your broker authorised to render advice services on the policy. · Underwriting Manager – the administrator who performs membership and claims administration functions of the insurer in terms of a binder agreement. 2. The policy contract is a contract of insurance between the insurer, in this case Constantia and yourself. 3. Following from 1 above, though Ambledown collects premiums on behalf of Constantia, premiums are collected into Constantia’s bank account. Similarly, if Ambledown pays claims on behalf of Constantia, claims are paid from Constantia’s bank account. 4. Due to Constantia’s liquidation, Ambledown’s binderholder mandate to act on behalf of Constantia was automatically terminated. Ambledown is not able to process and collect premiums for Constantia nor able to process and pay claims for Constantia as Ambledown does not have access to Constantia’s bank account anymore. 5. Ambledown is not part of the liquidation process and plays no role in resolution of Constantia’s estate, a liquidator was appointed through a regulated process. Ambledown does not have the mandate to put claims on behalf of member/creditors with the liquidator. 6. Constantia remained the underwriter on the policy until 31 August 2022, with Guardrisk taking over cover from 01 September 2022. The policy contract with Guardrisk is a new, independent contract, effective 01 September 2022. 7. Though Guardrisk allowed your membership to continue without imposing new waiting periods, Constantia’s premiums, and liabilities (claims) are not transferred over to the Guardrisk. 8. With the above in mind, Guardrisk nor Ambledown are not liable for the balance of the premiums. You may claim directly with Constantia’s liquidators in accordance with the Insolvency Act of 1936 by following the link https://www.constantiagroup.co.za/. Should you have any queries or need any further assistance please do not hesitate to contact us on ***. We trust that you will find the above explanation in order.
Yours Sincerely,Paul Makwea |***
Thank you for the review and kindly excuse the long response.
1. As at December 2021 when you changed products from a medical aid product to medical insurance, the role players to your insurance contract were· Insurer – Constantia Insurance Company Limited, your insurer (the risk carrier with whom your policy is placed) · Intermediary – NMG Consultants And Actuaries (Proprietary) Limited, your broker authorised to render advice services on the policy. · Underwriting Manager – the administrator who performs membership and claims administration functions of the insurer in terms of a binder agreement. 2. The policy contract is a contract of insurance between the insurer, in this case Constantia and yourself. 3. Following from 1 above, though Ambledown collects premiums on behalf of Constantia, premiums are collected into Constantia’s bank account. Similarly, if Ambledown pays claims on behalf of Constantia, claims are paid from Constantia’s bank account. 4. Due to Constantia’s liquidation, Ambledown’s binderholder mandate to act on behalf of Constantia was automatically terminated. Ambledown is not able to process and collect premiums for Constantia nor able to process and pay claims for Constantia as Ambledown does not have access to Constantia’s bank account anymore. 5. Ambledown is not part of the liquidation process and plays no role in resolution of Constantia’s estate, a liquidator was appointed through a regulated process. Ambledown does not have the mandate to put claims on behalf of member/creditors with the liquidator. 6. Constantia remained the underwriter on the policy until 31 August 2022, with Guardrisk taking over cover from 01 September 2022. The policy contract with Guardrisk is a new, independent contract, effective 01 September 2022. 7. Though Guardrisk allowed your membership to continue without imposing new waiting periods, Constantia’s premiums, and liabilities (claims) are not transferred over to the Guardrisk. 8. With the above in mind, Guardrisk nor Ambledown are not liable for the balance of the premiums. You may claim directly with Constantia’s liquidators in accordance with the Insolvency Act of 1936 by following the link https://www.constantiagroup.co.za/. Should you have any queries or need any further assistance please do not hesitate to contact us on ***. We trust that you will find the above explanation in order.
Yours Sincerely,Paul Makwea |***
Ambledown's reply22 Mar 2024, 08:18
Official
Dear Jacques T,
Thank you for the review and kindly excuse the long response.
1. As at December 2021 when you changed products from a medical aid product to medical insurance, the role players to your insurance contract were· Insurer – Constantia Insurance Company Limited, your insurer (the risk carrier with whom your policy is placed) · Intermediary – NMG Consultants And Actuaries (Proprietary) Limited, your broker authorised to render advice services on the policy. · Underwriting Manager – the administrator who performs membership and claims administration functions of the insurer in terms of a binder agreement. 2. The policy contract is a contract of insurance between the insurer, in this case Constantia and yourself. 3. Following from 1 above, though Ambledown collects premiums on behalf of Constantia, premiums are collected into Constantia’s bank account. Similarly, if Ambledown pays claims on behalf of Constantia, claims are paid from Constantia’s bank account. 4. Due to Constantia’s liquidation, Ambledown’s binderholder mandate to act on behalf of Constantia was automatically terminated. Ambledown is not able to process and collect premiums for Constantia nor able to process and pay claims for Constantia as Ambledown does not have access to Constantia’s bank account anymore. 5. Ambledown is not part of the liquidation process and plays no role in resolution of Constantia’s estate, a liquidator was appointed through a regulated process. Ambledown does not have the mandate to put claims on behalf of member/creditors with the liquidator. 6. Constantia remained the underwriter on the policy until 31 August 2022, with Guardrisk taking over cover from 01 September 2022. The policy contract with Guardrisk is a new, independent contract, effective 01 September 2022. 7. Though Guardrisk allowed your membership to continue without imposing new waiting periods, Constantia’s premiums, and liabilities (claims) are not transferred over to the Guardrisk. 8. With the above in mind, Guardrisk nor Ambledown are not liable for the balance of the premiums. You may claim directly with Constantia’s liquidators in accordance with the Insolvency Act of 1936 by following the link https://www.constantiagroup.co.za/. Should you have any queries or need any further assistance please do not hesitate to contact us on ***. We trust that you will find the above explanation in order.
Yours Sincerely,Paul Makwea |***
Thank you for the review and kindly excuse the long response.
1. As at December 2021 when you changed products from a medical aid product to medical insurance, the role players to your insurance contract were· Insurer – Constantia Insurance Company Limited, your insurer (the risk carrier with whom your policy is placed) · Intermediary – NMG Consultants And Actuaries (Proprietary) Limited, your broker authorised to render advice services on the policy. · Underwriting Manager – the administrator who performs membership and claims administration functions of the insurer in terms of a binder agreement. 2. The policy contract is a contract of insurance between the insurer, in this case Constantia and yourself. 3. Following from 1 above, though Ambledown collects premiums on behalf of Constantia, premiums are collected into Constantia’s bank account. Similarly, if Ambledown pays claims on behalf of Constantia, claims are paid from Constantia’s bank account. 4. Due to Constantia’s liquidation, Ambledown’s binderholder mandate to act on behalf of Constantia was automatically terminated. Ambledown is not able to process and collect premiums for Constantia nor able to process and pay claims for Constantia as Ambledown does not have access to Constantia’s bank account anymore. 5. Ambledown is not part of the liquidation process and plays no role in resolution of Constantia’s estate, a liquidator was appointed through a regulated process. Ambledown does not have the mandate to put claims on behalf of member/creditors with the liquidator. 6. Constantia remained the underwriter on the policy until 31 August 2022, with Guardrisk taking over cover from 01 September 2022. The policy contract with Guardrisk is a new, independent contract, effective 01 September 2022. 7. Though Guardrisk allowed your membership to continue without imposing new waiting periods, Constantia’s premiums, and liabilities (claims) are not transferred over to the Guardrisk. 8. With the above in mind, Guardrisk nor Ambledown are not liable for the balance of the premiums. You may claim directly with Constantia’s liquidators in accordance with the Insolvency Act of 1936 by following the link https://www.constantiagroup.co.za/. Should you have any queries or need any further assistance please do not hesitate to contact us on ***. We trust that you will find the above explanation in order.
Yours Sincerely,Paul Makwea |***