Failure to Honor Initial Conditions for Acceptance and Membership Certificate

I am lodging a formal complaint regarding the rejection of coverage for my dependant, despite compliance with GEMS’ stated processes and conditions.

1. Initial Submission: On 21 August 2025, I submitted the registration for my dependant, clearly indicating a pre-existing condition (pregnancy) on page 6 of the application. 2. Conditions for Acceptance: On 23 August 2025, GEMS issued conditions for acceptance, stating a general waiting period of 3 months. 3. Certificate of Membership: On 26 August 2025, I received a certificate of membership reflecting a waiting period from 1 September 2025 to 30 November 2025 for the dependant (######). 4. Authorization Granted: On 3 December 2025, I called GEMS for authorization for a delivery procedure, which was granted under authorization number ***3. 5. Contradictory Communication: On 11 December 2025, I was informed by the Maternity Rewards division that the dependant was not covered. Upon follow-up, I was told coverage was denied due to PMBs and received a new certificate stating a specific waiting period for pregnancy from 1 September 2025 to 31 August 2026, contradicting the initial certificate. 6. Escalation Attempts: I made multiple calls and escalations: o 12 December 2025 (***) – promised resolution in 2 working days. o Follow-up after 2 days – escalated with 3-day turnaround (***). o 29 December 2025 – second follow-up (***). o Visit to Arcadia Branch – Consultant Queen Mahlangu and her manager promised further escalation. Despite these efforts, no resolution has been provided. Basis of Complaint The initial agreement was based on the Conditions for Acceptance and the first certificate of membership received. GEMS’ failure to adhere to its own internal processes and contradictory documentation should not result in financial or emotional burden on me. I request urgent resolution and reinstatement of coverage as per the original terms.