Manipulative and misleading

Dear Dischem Health Team,

I am writing to formally lodge a complaint and request a full reimbur*****t regarding the medical insurance policy my husband and I took out with your institution in September last year.

Over the past several months, we have diligently paid monthly premiums amounting to approximately R14,000. During this period, we did not submit a single claim—until recently—when we scheduled a routine GP consultation. According to the terms of the policy, GP visits are stated to be unlimited. However, to our shock, we received a statement shortly after the consultation informing us that the claim had been rejected. Upon querying this, we were told that it is “not covered.”

This was the first and only claim we attempted to make. It is unacceptable for a provider to advertise unlimited GP visits and then deny the very claim that should have been honoured under that condition. The lack of transparency and conflicting information provided to consumers violates the principles of fair and honest dealing.

Understandably, after experiencing this, we decided to cancel the policy and requested a refund of the contributions made, as we received no value or benefit from the cover. Your cancellation policy states that a calendar month’s notice is required for termination. We adhered to this and submitted the cancellation notice a few days ago, clearly indicating our concerns and referencing the request for reimbur*****t.

However, we have since been informed that: 1. The cancellation will be processed at the end of this month, not the end of June, and 2. No reimbur*****t will be considered due to the timing of our notice.

This response appears to be a deliberate manipulation of policy timing to avoid paying a refund, despite our clear intent to provide notice in accordance with your stated terms. This practice is not only ethically questionable but may also constitute unfair conduct under the Consumer Protection Act, Section 48, which protects consumers from unfair, unreasonable, or unjust contract terms and conditions.

The fact that our first and only claim was rejected under false pretenses shows the policy was never intended to serve our medical needs as advertised. This is a clear breach of Section 54 of the CPA, which entitles consumers to services of reasonable quality and benefit.

I respectfully demand: • Immediate processing of the cancellation effective 30 June (as per calendar month’s notice), • A full reimbur*****t of all premiums paid, or at minimum, a pro-rata refund for the months during which no benefits were received, and • Written confirmation that our complaint is being investigated with urgency.

Should this matter remain unresolved, I will have no choice but to escalate it to the Council for Medical Schemes and the Consumer Goods and Services Ombud, as I believe our rights as consumers have been blatantly violated.

I trust that this matter will be handled with the seriousness and integrity it deserves.