GEMS TO SETTLLE ALL MY BILLS

Good day

On the 20th June 2018 I received a call from Norman at mediclinic. He informed that GEMS didn’t pay the Hospital. I just find out from him (Norma) because GEMS didn’t communicate when they cancel my dependant. (*****goa) from the Medical aid.

I called GEMS on 25 June 2018 REF: MH ********** 8 around 15:30 and spoke to Clarance Monare. I explained the whole situation to him, he consulted his team supervisor (Thabo Marumo), Clarance came back to he told me that I should check on Monday he escalated the matter to his Team supervisor (Thabo Marumo). I asked if they are going to call me on Monday he told me to call and do a follow up.

On Monday I went to GEMS walk in centre in Polokwane, I was assisted my Vusi Nkomo at 8:30 REF: MH ********** 4 and REF MH ********** 6. He told me that they have reinstated my dependant it was a mistake, all the claims will be paid. I forgot to request a reference number from Vusi Nkomo.

The very same day I called GEMS to request reference number for my visit at walk in centre. I spoke to Maria Mokgalaka she told me that Vusi send only a payment for Muruya he didn’t do for all the outstanding invoices. Maria Mokgalaka *** forwarded all the remaining claims to their back office in the claim department promised me that they will go through for payment and requested me to call GEMS on Monday the 02 July 2018.

On the 28 July I spoke to Lizzy Lekalakala (Ref: MH ********** 4) I explained the whole story to her, she told me that my account is a mess, there are payment and reversals. She put me on hold to consult her team Supervisor David Mdaka. she told me that there is money that will be deposited into my account, I told her that I don’t need money, I want GEMS to pay all the service providers that they owe on my account. Lizzy promised to call

The next thing today on the 02 July 2018 an amount of R5 730.94 was paid into my account. I called GEMS Ref No. spoke to a consultant explained the story to them, but till today I don’t get any positive respond.

1. GEMS did not communicate anything to me when they cancel my dependant

• I wrote a letter to GEMS on January 2018 requested them to move my child dependant to adult dependant from 1 April 2018. The premium went up because she was indeed move from child to adult • I also made telephone follow up on the matter: • I spoke to Anna Sambo on the 27/03/2018 *** she confirmed that my request in writing was loaded on the system and also confirmed that the child will be moved to adult • On the 22 February 2018 I spoke to a consultant REFMH ********** 6 hey also confirmed that the request is loaded on the system • Yet my dependant was terminated on the medical aid on the 30 April due to the fact that I didn’t submit a proof of registration. Where do I get those proofs since I wrote a letter for the dependant to be moved to adult dependant • Again even though I didn’t submit a proof there is a clause on your website under Membership that says “ IN THE EVENT T •

2. They don’t want to take any responsibility 3. They only thing that they do, they told me to pay the service provider myself with the money they deposited into my account 4. GEMS expect me to run around pay the bills on their behalf after the mess they caused me, now my name is being handed over for non-payments of invoices

All the consultant when I explain my story to them they just put me on hold for about 45 minutes. Nobody want to give me a solution to his problem.

Everything when ask, I am told it’s a mistake, it’s their mistakes why don’t they fix them.

Dr Murya R7117.50 I requested GEMS not to pay but instead they paid it into my bank account and expect me to pay the service providers Mediclinic R7986.01 I requested GEMS not to pay but instead they paid it into my bank account and expect me to pay the service providers

R32.50 short payment of R437.90 A claim R470.10 was submitted to GEMS by service provider, GEMS only paid R32.50 they said it was a mistake Mediclinic R28 357.00 Still outstanding

Eligibility review - Implementation of Rule 4.9.5

The implementation of Rule 4.9.5 allows for students studying short courses at any time during the year, to now be registered at the child rate. Previously you could only register your dependant for child rates if he/she studied as a full-time student. The implementation of Rule 4.9.5 means that there will now be eligibility reviews conducted throughout the year, triggered by students' study completion dates.

The new short course rule allows a Principal Member to pay a child rate for a dependant for the duration of his/her registration on a short course, which child rate will revert back to an adult rate after the completion date of the short course. For example, in the event of a student studying a three month diploma course at an educational institution, the Principal Member will be required to pay a child rate during the three month course period and will be required to pay an adult rate thereafter.

In the event that you do not supply proof on time, the dependant will be converted to an adult rate. That means you will be charged adult rates until you supply proof of studies or written notice to terminate the dependant's membership

Since my dependant was terminated on the medical aid from the 1 April even though I’ve submitted all the necessary documents. I think the above highlighted clause from GEMS website should have covered her. the above clause is not legit, Patricia Tsale (REF 562525) explained that if the dependant did not submit proof of registration she will moved to an adult dependant but they suspend the benefits, which the clause does not explain that. According to me the clause says if you do not submit a proof on time the dependant will be converted to adult dependant and still enjoy her benefits. GEMS didn’t mention anything about suspending the benefits on the website. GEMS is misleading us with their clause that ins on the website.