HIGHLY DISAPPOINTED and TOTALLY DISGUSTED at how FEDHEALTH treats their clients!!!

I am HIGHLY DISAPPOINTED and TOTALLY DISGUSTED at how FEDHEALTH treats their clients!!! 1. My grandson was born 15/06/2023. He was admitted into the NICU ward immediately with Jaundice that was so bad that if left untreated he would have had brain damage or even worse 2. He had to stay in NICU for 6 days 3. Hospital requested authorisation for this treatment… was pending due to beneficiary not registered yet 4. My grandson was registered onto my membership as a child dependant 5. Scheme decided to join him from 01.07.2023 with a 3-month waiting period meaning his benefits would only kick in 01.10.2023 6. I was told the adding of the dependants was received and processed in line with scheme rules and that underwriting and waiting periods were app**** correctly 7. Now I was clearly under the impression that due to the emergency treatment my grandson had to receive as it is a PMB condition, which by law, all schemes need to adhere to and pay such claims 8. After requesting the underwriting and claims to be reviewed again, I was told yet again underwriting was app**** correctly and since he is my grandchild, he was not “born into the scheme” and would not be registered from date of birth but only the month after birth regardless of the documents been received within 30 days of the birth date 9. After requesting yet another review on the PMB claim, I was told that my grandson claims have been rejected as his joining date is from 01/07/2023 and the claims are for the month of June 10. I was also told that although the scheme knew the conditions is a PMB and the treatment was medically necessary, due to the claims being submitted prior to the join date, they are unable to review the claims as per Scheme rules and benefits 11. And as per Scheme rules, the underwriting and addition of a 3rd generation dependant has been processed and app**** correctly, and the scheme is unable to backdate inception date of dependant or remove the general waiting period app**** UNABLE TO >>> OR WONT??? 12. According to the Medical Schemes act regarding Registration of Dependants – 7.1.2 Clearly states the following: If a member applies to register a newborn or newly adopted child as a dependant within 30 days of the date of birth or adoption of the child, increased contributions shall then be due as from the first day of the month following the month of birth or adoption and benefits will accure as from the date of birth or adoption

The same act under Waiting Periods – 9.5 A Child born to any beneficiary, whether as a member or a dependant, is automatically regarded as a child dependant of the member concerned and is entitled to immediate coverage without application of a general or any condition-specific waiting period subject to rule 7.1.2

13. FEDHEALTH Main Scheme Rules updated 24.03.2023 as follows: Page 12- Registration of Dependants 7.1.3 EXACTLY THE SAME AS THE MEDICAL SCHEMES ACT WORD FOR WORD Page 14 Waiting Periods 8.4 No waiting periods may be imposed on a child dependant born during the period of membership. A medical scheme may not impose a general or condition specific waiting period on a person in respect of whom application is made for membership or for admission as a dependant

14. I am so sick and tired of having to read and hear my grandson is a third-generation baby as per scheme rules 15. Now call me blind, but NO WHERE in any scheme rules of the actual ACT or FEDHEALTH rules anywhere do I see those word…. only in the brochures provided for every year and it mentioned on google… 16. I feel strongly that the SCHEME RULES have governance over what some brochure says. It is ******** and ********* for the Scheme Rules wording not to match the brochures. The brochures are very misleading and is gives false messages 17. I find the way I have been treated is ********* and in poor taste and not a good image for FEDHEALTH to be reflecting upon themselves 18. I have requested for a breakdown of the new contribution that will be deducted from my bank account end of the month – yet to still receive a response 19. I have asked if my contributions as I am still the active main member, cannot be used to carry my grandsons treatment of June – yet to still receive a response 20. I also suggested a compromise or remedy for me to pay an additional contribution backdated for June to cover the treatment – yet to still receive a response 21. I would however, like to know where has all my years of contributions gone. To whom have they gone…. I am very well convinced that quite a few months and a year or 2 of contributions is enough to settle the claims of my grandson treatment 22. I have paid so many years for contributions and I have had ZERO CLAIMS on MYSELF and have never been admitted into hospital whatsoever. But the one time that I need the Scheme to assist me there are issues and excuses a mile long. 23. I feel the reason for denial of the treatment and payment of the claims relating to this treatment is very unfair and selfish. Do you get some pleasure out of trying to make your clients suffer. I pay month after month…and all I am asking is just some sort of compromise to remedy this situation and to meet me halfway here 24. I have always felt proud to be part of FEDHEALTH and have always had good words and given praise where it is due, now I am highly disappointed and truly embarrassed at the way FEDHEALTH treats its clients 25. I am in hope that you will have a heart and review this treatment once again and settle the claims for my grandsons treatment and pay the claims as I have exhaust all avenues of sending tireless emails. I have now had to resort to social media for you to see and hear my pleas and cries for help

26. If no assistance is provided for on this platform. What is next Medical Ombudsman …Council for Medical Schemes perhaps???