RP
Rubashini P

1 reviews | Active since Dec 2024

09 Dec 2024, 17:58

GEMS: Waiting periods are misleading

I added my mother-in-law aged 76 on my medical aid scheme at the beginning of April 2024. They did not contact me to inform me that the application was only processed in May. In June I received an sms stating that I need to accept terms and conditions which suggested that the waiting period ends in September. I called gems to find out why the waiting period did not commence in May and was told that processing takes a while and I expressed my concern for my elderly mother in law who is on chronic meds and urgently needs cover. They offered me an option to waiver the waiting period if I paid an amount of approximately R10 000. I did not have the funds available so I then had to except the waiting period a month later after making numerous calls and being transfered to different departments to no avail. The waiting general waiting concluded at the end of November due to my dispute with their lack of efficiency. The membership letter states that PMB conditions will be covered in "certain cases" within in the specific condition waiting period. However, on the 9th of December, my mother-in law had a serious episode of hypertension and her specialist suggested admission. Gems declined the admission saying that they cannot cover due to the 'specific condition waiting period' . I called their contact centre and was once again transferred to numerous departments. An employee in the authorization department refused to put me through to the PMB department saying that they won't cover because my mother in law was not on a medical aid prior to her being registered on Gems. We'll, she was but unfortunately her spouse passed away and there was a periods a few months when she wasn't on any medical aid. This is very frustrating because the membership letter did not specify that this was the clause. Hence, my mother in law is registered on the medical aid but cannot receive medical treatment for life threatening existing conditions. I feel that this is unfair because the membership letter is ambiguous by suggesting that PMB conditions will be covered in "certain cases"

0
Replies (1)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply10 Dec 2024, 09:28
Official
Good day,

Thank you for engaging with us. We are attending to your message and feedback will be provided. If you have an urgent query, please contact us on: ***(members) & ***(providers).
 
 Call Centre Hours: Monday - Friday: 8h00 - 17h00 & Saturday: 8h00 - 12h00. Emergency number: ***(available 24 hours)
 
 If you wish to submit a compliment, please email us on at ***. We look forward to receiving your positive feedback. 
 
Regards,

GEMS